| |
1756 E Center St Madisonville KY 42431-2253 | |
(270) 821-3300 | |
(270) 821-2100 |
Full Name | |
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Speciality | Family Medicine |
Location | 1756 E Center St, Madisonville, Kentucky |
Authorized Official Name and Position | E Berton Whitaker (CEO) |
Authorized Official Contact | 2708255857 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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900 Hospital Dr Madisonville KY 42431-1644 Ph: (270) 825-5100 | 1756 E Center St Madisonville KY 42431-2253 Ph: (270) 821-3300 |
NPI Number | 1821398603 |
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Provider Enumeration Date | 10/27/2010 |
Last Update Date | 04/24/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821398603 | NPI | - | NPPES |
7100149860 | Medicaid | KY | |
689131 | Other | KY | ANTHEM GROUP # |
7100192750 | Other | KY | MEDICAID PHYSICIAN GROUP# |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Kentucky) | Primary |
207R00000X | Internal Medicine | (Kentucky) | Secondary |
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