Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 211 Ky 59, Vanceburg, Kentucky |
Authorized Official Name and Position | Jerry Ugrin (CEO) |
Authorized Official Contact | 6067963029 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 550 Vanceburg KY 41179-0550 Ph: (606) 796-3029 | 211 Ky 59 Vanceburg KY 41179-7647 Ph: (606) 796-3029 |
NPI Number | 1043336506 |
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Provider Enumeration Date | 03/22/2007 |
Last Update Date | 01/19/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043336506 | NPI | - | NPPES |
31000268 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 100989 (Kentucky) | Primary |