IRA B POTTER PSC; NPI #1962401455

Contact Information

IRA B POTTER PSC

77 MILLARD ALLEN DR.
LACKEY, KY 41643-0190

Phone: 606-358-2381
Fax: 606-358-2404
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Medical Specialty	261QM2500X
Physician Assistant	363A00000X	97	Physician Assistant

Indicates primary specialty

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NPI Profile & details for IRA B POTTER PSC

NPI # 1962401455

LBN Legal business name IRA B POTTER PSC

Authorized official IRA POTTER - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 07/18/2005

Last updated 03/21/2016 - About 10 years ago

Identifiers

KY	License #	PA1587
KY	Medicaid	65901399
KY	Other	000000057539	ANTHEM

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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