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102 Rhodes St Gamaliel KY 42140-8942 | |
(270) 457-3000 | |
(270) 457-2315 |
Full Name | |
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Speciality | Clinic/Center |
Location | 102 Rhodes St, Gamaliel, Kentucky |
Authorized Official Name and Position | Phyllis B Amonett (CREDENTIALING) |
Authorized Official Contact | 2708641472 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1080 Burkesville KY 42717-1080 Ph: (270) 864-1472 | 102 Rhodes St Gamaliel KY 42140-8942 Ph: (270) 457-3000 |
NPI Number | 1528464385 |
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Provider Enumeration Date | 11/06/2014 |
Last Update Date | 11/07/2014 |
Medicare PECOS PAC ID | 6305947789 |
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Medicare Enrollment ID | O20150814014182 |
Identifier | Type | State | Issuer |
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1528464385 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700172 (Kentucky) | Primary |