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1000 Neighborhood Pl Fairdale KY 40118-9697 | |
(502) 361-2381 | |
(502) 363-1462 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1000 Neighborhood Pl, Fairdale, Kentucky |
Authorized Official Name and Position | Bart Irwin (CEO (INTERIM)) |
Authorized Official Contact | 5027748631 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 950244 Louisville KY 40295-0244 Ph: (502) 953-4700 | 1000 Neighborhood Pl Fairdale KY 40118-9697 Ph: (502) 361-2381 |
NPI Number | 1871546119 |
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Provider Enumeration Date | 05/18/2006 |
Last Update Date | 07/16/2021 |
Medicare PECOS PAC ID | 6901700053 |
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Medicare Enrollment ID | O20100625000535 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871546119 | NPI | - | NPPES |
31000052 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700013 (Kentucky) | Primary |