Provider Demographics
NPI:1053807206
Name:CAPITOL PAIN OF KENTUCKY, PLLC
Entity type:Organization
Organization Name:CAPITOL PAIN OF KENTUCKY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-229-5366
Mailing Address - Street 1:7951 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7534
Mailing Address - Country:US
Mailing Address - Phone:512-467-7246
Mailing Address - Fax:
Practice Address - Street 1:3841 RUCKRIEGEL PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:512-467-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty