National Provider Identifier Database

IRA B POTTER PSC
Medical Specialty

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).


Contact Information

IRA B POTTER PSC
77 MILLARD ALLEN DR.
LACKEY, KY41643-0190
Phone: 606-358-2381
Fax: 606-358-2404
Website:
Specialty Taxonomy Code
* Medical Specialty 261QM2500X
Physician Assistant 363A00000X

* Indicates primary specialty

NPI Profile & details for IRA B POTTER PSC

NPI Number 1962401455
Legal business name
LBN
IRA B POTTER PSC
Authorized official IRA POTTER - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 07/18/2005
Last updated 03/21/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • KY License #: PA1587
  • KY Medicaid: 65901399
  • KY Other: 000000057539 ANTHEM

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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