Provider Demographics
NPI:1487766812
Name:KENTUCKY LUNG CLINIC, INC
Entity type:Organization
Organization Name:KENTUCKY LUNG CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-487-1818
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:STE. 2M
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-487-1818
Mailing Address - Fax:606-487-8448
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:STE. 2M
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-487-1818
Practice Address - Fax:606-487-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7700Medicare ID - Type Unspecified