| Fort Logan Healthy Kids Clinic | |
|
305 Danville Ave Stanford KY 40484-1205 | |
| (844) 435-0900 | |
| (270) 858-4029 |
| Full Name | Fort Logan Healthy Kids Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 305 Danville Ave, Stanford, Kentucky |
| Authorized Official Name and Position | Eric E Loy (CEO) |
| Authorized Official Contact | 2708641472 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Logan Healthy Kids Clinic Po Box 1080 Burkesville KY 42717-1080 Ph: (270) 858-6644 | Fort Logan Healthy Kids Clinic 305 Danville Ave Stanford KY 40484-1205 Ph: (844) 435-0900 |
| NPI Number | 1306377072 |
|---|---|
| Provider Enumeration Date | 03/24/2017 |
| Last Update Date | 03/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306377072 | NPI | - | NPPES |
| 7100017280 | Medicaid | KY | |
| 700172 | Other | KY | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700172 (Kentucky) | Primary |
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