Provider Demographics
NPI:1851998181
Name:SPECIALISTSMAT PSC
Entity type:Organization
Organization Name:SPECIALISTSMAT PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NETHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-248-6415
Mailing Address - Street 1:110 CHASE WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7827
Mailing Address - Country:US
Mailing Address - Phone:502-212-0071
Mailing Address - Fax:502-996-8359
Practice Address - Street 1:110 CHASE WAY STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7827
Practice Address - Country:US
Practice Address - Phone:502-212-0071
Practice Address - Fax:502-530-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty