| Full Name | |
|---|---|
| Speciality | Surgery |
| Location | 60 Mercy Ct, Irvine, Kentucky |
| Authorized Official Name and Position | Trena Lynn Stocker (PRESIDENT) |
| Authorized Official Contact | 8597790148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 636544 Cincinnati OH 45263-6544 Ph: (606) 723-2115 | 60 Mercy Ct Irvine KY 40336-1331 Ph: (606) 723-2115 |
| NPI Number | 1770734691 |
|---|---|
| Provider Enumeration Date | 10/09/2008 |
| Last Update Date | 03/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770734691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208600000X | Surgery | (Kentucky) | Primary |
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