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46 West Main Str. Brodhead KY 40409 | |
(606) 758-4748 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 46 West Main Str., Brodhead, Kentucky |
Authorized Official Name and Position | Brandy Bullock (DIRECTOR) |
Authorized Official Contact | 6062562195 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P.o.box 1310 Mount Vernon KY 40456-2728 Ph: () - | 46 West Main Str. Brodhead KY 40409 Ph: (606) 758-4748 |
NPI Number | 1295275972 |
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Provider Enumeration Date | 03/01/2017 |
Last Update Date | 06/09/2017 |
Medicare PECOS PAC ID | 6103727433 |
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Medicare Enrollment ID | O20170814002766 |
Identifier | Type | State | Issuer |
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1295275972 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | 900315 (Kentucky) | Primary |