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305 Danville Ave Stanford KY 40484-1205 | |
(844) 435-0900 | |
(270) 858-4029 |
Full Name | |
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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 |
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Po Box 1080 Burkesville KY 42717-1080 Ph: (270) 858-6644 | 305 Danville Ave Stanford KY 40484-1205 Ph: (844) 435-0900 |
NPI Number | 1306377072 |
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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 |