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IRA B POTTER PSC NPI 1962401455


NPI Information

NPI: 1962401455
Provider Name: IRA B POTTER PSC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

Address:
77 MILLARD ALLEN DR.
LACKEY, KY
ZIP 41643
Phone: (606) 358-2381
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IRA B POTTER PSC is a medical specialty clinic center in Lackey, KY. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). IRA B POTTER PSC NPI is 1962401455. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

77 MILLARD ALLEN DR.
LACKEY, KY
ZIP 41643-190
Phone: (606) 358-2381
Fax: (606) 358-2404

The provider's authorized official is Ira Blaine Potter .
The authorized official title is President and has the following contact phone number (606) 358-2381.

The enumeration date for this NPI number is 7/18/2005 and was last updated on 3/21/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician AssistantPA1587KENTUCKYNo
2261QM2500XClinic/CenterMedical SpecialtyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12763MEDICARE PINKENTUCKY
2000000057539OTHERKENTUCKYANTHEM
365901399MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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