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3615 E John Rowan Blvd Ste 104 Bardstown KY 40004-3264 | |
(502) 348-5968 | |
(270) 706-5802 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3615 E John Rowan Blvd Ste 104, Bardstown, Kentucky |
Authorized Official Name and Position | Danyel D Clay (VICE PRESIDENT REVENUE CYCLE) |
Authorized Official Contact | 5022534911 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1901 Campus Pl Louisville KY 40299-2308 Ph: (502) 253-4911 | 3615 E John Rowan Blvd Ste 104 Bardstown KY 40004-3264 Ph: (502) 348-5968 |
NPI Number | 1194320630 |
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Provider Enumeration Date | 12/02/2020 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 5597867184 |
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Medicare Enrollment ID | O20211117000768 |
Identifier | Type | State | Issuer |
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1194320630 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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