Provider Demographics
NPI:1972792034
Name:DR. MELISSA DAVIS, P.S.C.
Entity type:Organization
Organization Name:DR. MELISSA DAVIS, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-9644
Mailing Address - Street 1:2222 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7847
Mailing Address - Country:US
Mailing Address - Phone:606-325-9644
Mailing Address - Fax:606-329-1207
Practice Address - Street 1:2222 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7847
Practice Address - Country:US
Practice Address - Phone:606-325-9644
Practice Address - Fax:606-329-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9563Medicare PIN
KYI26506Medicare UPIN