| Breathitt County Family Health Center | |
|
1484 Lakeside Drive Jackson KY 41339-7370 | |
| (606) 666-9950 | |
| (606) 666-9136 |
| Full Name | Breathitt County Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1484 Lakeside Drive, Jackson, Kentucky |
| Authorized Official Name and Position | Derrick J Hamilton (CEO) |
| Authorized Official Contact | 6066669950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breathitt County Family Health Center Po Box 690 141 Main Street Beattyville KY 41311-0690 Ph: (606) 464-0151 | Breathitt County Family Health Center 1484 Lakeside Drive Jackson KY 41339-7370 Ph: (606) 666-9950 |
| NPI Number | 1467417691 |
|---|---|
| Provider Enumeration Date | 04/19/2006 |
| Last Update Date | 07/14/2020 |
| Medicare PECOS PAC ID | 2961453618 |
|---|---|
| Medicare Enrollment ID | O20060131000899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467417691 | NPI | - | NPPES |
| 181853 | Other | KY | MEDICARE FQHC PTAN |
| 31000854 | Medicaid | KY | |
| 9521 | Other | KY | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700140 (Kentucky) | Primary |
Dr. Rodney B. Griffith Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1462 Highway 15 N, Jackson, KY 41339 Phone: 606-666-2966 Fax: 606-666-7526 | |
Breathitt Dental Clinic Psc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 221 Highway 15 S, Jackson, KY 41339 Phone: 606-666-4020 Fax: 606-666-4021 |