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1700 Cargo Ct Jeffersontown KY 40299-1938 | |
| (502) 749-6764 | |
| (502) 749-6843 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 Cargo Ct, Jeffersontown, Kentucky |
| Authorized Official Name and Position | Rupert Mccormac (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8008056989 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 749057 Atlanta GA 30374-9057 Ph: (800) 805-6989 | 1700 Cargo Ct Jeffersontown KY 40299-1938 Ph: (502) 749-6764 |
| NPI Number | 1649797507 |
|---|---|
| Provider Enumeration Date | 08/23/2017 |
| Last Update Date | 07/12/2024 |
| Certification Date | 07/12/2024 |
| Medicare PECOS PAC ID | 7416382023 |
|---|---|
| Medicare Enrollment ID | O20200108001559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649797507 | NPI | - | NPPES |
| 810552 | Other | KY | STATE LICENSE |