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206 Richmond Rd N Berea KY 40403-1319 | |
| (859) 986-8491 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 206 Richmond Rd N, Berea, Kentucky |
| Authorized Official Name and Position | Logan Roy Antle (CEO) |
| Authorized Official Contact | 6064255768 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
521 Crane Rd Somerset KY 42501-9503 Ph: (606) 425-5768 | 206 Richmond Rd N Berea KY 40403-1319 Ph: (859) 986-8491 |
| NPI Number | 1326818238 |
|---|---|
| Provider Enumeration Date | 01/03/2024 |
| Last Update Date | 01/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326818238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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