Provider Demographics
NPI:1720719172
Name:IMAC MEDICAL OF KENTUCKY PSC
Entity type:Organization
Organization Name:IMAC MEDICAL OF KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BAILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-678-0024
Mailing Address - Street 1:1605 WESTGATE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8396
Mailing Address - Country:US
Mailing Address - Phone:615-637-7333
Mailing Address - Fax:615-663-7334
Practice Address - Street 1:2725 JAMES SANDERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8405
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:270-215-4834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMAC MEDICAL OF KENTUCKY PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies