| Family Health Center Phoenix | |
|
712 E Muhammad Ali Blvd Louisville KY 40202-1643 | |
| (502) 568-6972 | |
| (502) 587-6683 |
| Full Name | Family Health Center Phoenix |
|---|---|
| Speciality | Clinic/Center |
| Location | 712 E Muhammad Ali Blvd, Louisville, 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 |
|---|---|
| Family Health Center Phoenix Po Box 950244 Louisville KY 40295-0244 Ph: (502) 953-4700 | Family Health Center Phoenix 712 E Muhammad Ali Blvd Louisville KY 40202-1643 Ph: (502) 568-6972 |
| NPI Number | 1205889540 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 07/16/2021 |
| Medicare PECOS PAC ID | 6901700053 |
|---|---|
| Medicare Enrollment ID | O20100625000892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205889540 | NPI | - | NPPES |
| 31000052 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700013 (Kentucky) | Primary |
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