| Phoenix Preferred Care, Inc. | |
|
201 E Mount Vernon St Somerset KY 42501-1412 | |
| (606) 451-9379 | |
| (606) 451-8149 |
| Full Name | Phoenix Preferred Care, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 201 E Mount Vernon St, Somerset, Kentucky |
| Authorized Official Name and Position | Tina M Hamm (CFO) |
| Authorized Official Contact | 6064519379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Preferred Care, Inc. Po Box 2 Somerset KY 42502-0002 Ph: (606) 451-9379 | Phoenix Preferred Care, Inc. 201 E Mount Vernon St Somerset KY 42501-1412 Ph: (606) 451-9379 |
| NPI Number | 1639290596 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7315347168 |
|---|---|
| Medicare Enrollment ID | O20210615003391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639290596 | NPI | - | NPPES |
| 29101847 | Other | KY | IMPACT PLUS PROVIDER ID |
| 29201845 | Other | KY | IMPACT PLUS PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 069364 (Kentucky) | Primary |
| Provider Name | Brian Tucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386040335 PECOS PAC ID: 2062775349 Enrollment ID: I20180419001776 |
| Provider Name | Gwen West |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689954778 PECOS PAC ID: 1759781503 Enrollment ID: I20210615003462 |
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