| Family Wellcare Clinic, Pllc | |
|
805 Bardstown Rd Ste 12 Springfield KY 40069 | |
| (859) 481-7113 | |
| (859) 481-7114 |
| Full Name | Family Wellcare Clinic, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 805 Bardstown Rd Ste 12, Springfield, Kentucky |
| Authorized Official Name and Position | Imad Antone Haddad (MANAGER) |
| Authorized Official Contact | 8594817113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Wellcare Clinic, Pllc 805 Bardstown Rd Ste 12 Springfield KY 40069-1515 Ph: (859) 481-7113 | Family Wellcare Clinic, Pllc 805 Bardstown Rd Ste 12 Springfield KY 40069 Ph: (859) 481-7113 |
| NPI Number | 1619496395 |
|---|---|
| Provider Enumeration Date | 09/14/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4688940240 |
|---|---|
| Medicare Enrollment ID | O20171026000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619496395 | NPI | - | NPPES |
| 64065865 | Medicaid | KY |
| Provider Name | Imad A Haddad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508880063 PECOS PAC ID: 5496643181 Enrollment ID: I20040305000033 |
| Provider Name | Derhonda M Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063821379 PECOS PAC ID: 0749400901 Enrollment ID: I20141010000296 |
| Provider Name | Laura Michelle Oldham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932754298 PECOS PAC ID: 5092142620 Enrollment ID: I20200220002403 |
| Provider Name | Kristen Renee Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013526417 PECOS PAC ID: 9537584727 Enrollment ID: I20200805001206 |
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