| Stanford Wellcare Clinic Pllc | |
|
132 Frontier Blvd Ste 101 Stanford KY 40484-6516 | |
| (606) 727-5757 | |
| (606) 727-5777 |
| Full Name | Stanford Wellcare Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 132 Frontier Blvd Ste 101, Stanford, Kentucky |
| Authorized Official Name and Position | Imad A Haddad (OWNER) |
| Authorized Official Contact | 8594817113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanford Wellcare Clinic Pllc 132 Frontier Blvd Ste 101 Stanford KY 40484-6516 Ph: (606) 727-5757 | Stanford Wellcare Clinic Pllc 132 Frontier Blvd Ste 101 Stanford KY 40484-6516 Ph: (606) 727-5757 |
| NPI Number | 1861071219 |
|---|---|
| Provider Enumeration Date | 04/05/2021 |
| Last Update Date | 08/03/2021 |
| Medicare PECOS PAC ID | 3375945785 |
|---|---|
| Medicare Enrollment ID | O20210707003906 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861071219 | NPI | - | NPPES |
| Provider Name | Imad A Haddad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508880063 PECOS PAC ID: 5496643181 Enrollment ID: I20040305000033 |
| 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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