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100 State Route 80 E Arlington KY 42021-9016 | |
(270) 267-0051 | |
(270) 251-4546 |
Full Name | |
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Speciality | Clinic/Center |
Location | 100 State Route 80 E, Arlington, Kentucky |
Authorized Official Name and Position | David R Zetter (SOLE MBR) |
Authorized Official Contact | 2702514562 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1029 Medical Center Cir Ste 200 Mayfield KY 42066-1189 Ph: (270) 251-4562 | 100 State Route 80 E Arlington KY 42021-9016 Ph: (270) 267-0051 |
NPI Number | 1629579180 |
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Provider Enumeration Date | 02/21/2018 |
Last Update Date | 02/21/2018 |
Medicare PECOS PAC ID | 5597020875 |
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Medicare Enrollment ID | O20180607002956 |
Identifier | Type | State | Issuer |
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1629579180 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 31625 (Kentucky) | Primary |
Provider Name | David R Zetter |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598711756 PECOS PAC ID: 2860664513 Enrollment ID: I20110930000613 |