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7629 Ky Route 979 Grethel KY 41631-6304 | |
(606) 587-2200 | |
(606) 587-2203 |
Full Name | |
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Speciality | Clinic/Center |
Location | 7629 Ky Route 979, Grethel, Kentucky |
Authorized Official Name and Position | Ancil W Lewis (CEO) |
Authorized Official Contact | 6068868546 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1709 Ky Route 321 Suite 3 Prestonsburg KY 41653-9097 Ph: (606) 886-8546 | 7629 Ky Route 979 Grethel KY 41631-6304 Ph: (606) 587-2200 |
NPI Number | 1154367191 |
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Provider Enumeration Date | 06/20/2006 |
Last Update Date | 08/20/2013 |
Medicare PECOS PAC ID | 1951211218 |
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Medicare Enrollment ID | O20101011001129 |
Identifier | Type | State | Issuer |
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1154367191 | NPI | - | NPPES |
31000177 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700032 (Kentucky) | Primary |