Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2023-06-22
- Last updated
- 2025-09-04
Licenses
The registry row did not include a license.
Location
- Practice location
- 500 NORTHSIDE DR
- City
- MIDWAY KY
- Postal code
- 403471106
- Phone
- 859-879-4690
Organization contact
- Name
- ERIC LOY
- Title
- CEO
- Phone
- 2708586655
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.