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Contact Information

BEN W BACK, PA
210 BLACK GOLD BLVD STE 106
HAZARD, KY41701-2620
 Phone: 606-436-0711
 Fax: 606-436-0848
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for BEN W BACK · (Male)

NPI # 1619942562
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 02/22/2006
Last updated 05/13/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • KY License # PA364
  • KY Medicaid 95000287
Hospital affiliation(s)
  • HAZARD ARH REGIONAL MEDICAL CENTER - (Acute Care)
    100 MEDICAL CENTER DRIVE
    HAZARD, KY 41701
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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