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428 Hustonville Street Liberty KY 42539-3140 | |
| (606) 787-0180 | |
| (606) 787-0104 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 428 Hustonville Street, Liberty, Kentucky |
| Authorized Official Name and Position | Eric E Loy (CEO) |
| Authorized Official Contact | 2708586655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2399 Russell Springs KY 42642-2399 Ph: (270) 858-6655 | 428 Hustonville Street Liberty KY 42539-3140 Ph: (606) 787-0180 |
| NPI Number | 1902228075 |
|---|---|
| Provider Enumeration Date | 01/09/2014 |
| Last Update Date | 03/28/2024 |
| Medicare PECOS PAC ID | 6305947789 |
|---|---|
| Medicare Enrollment ID | O20240627002669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902228075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Kentucky) | Primary |
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