| Grand Lakes Clinic | |
|
1860 J.h. O'bryan Ave. Grand Rivers KY 42045 | |
| (270) 362-8246 | |
| (270) 362-9757 |
| Full Name | Grand Lakes Clinic |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1860 J.h. O'bryan Ave., Grand Rivers, Kentucky |
| Authorized Official Name and Position | Mark A Edwards (ADMINISTRATOR//CEO) |
| Authorized Official Contact | 2709887235 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Lakes Clinic 131 Hospital Dr Salem KY 42078-8043 Ph: (270) 988-7296 | Grand Lakes Clinic 1860 J.h. O'bryan Ave. Grand Rivers KY 42045 Ph: (270) 362-8246 |
| NPI Number | 1669612008 |
|---|---|
| Provider Enumeration Date | 02/25/2009 |
| Last Update Date | 08/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669612008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 900135 (Kentucky) | Primary |
Grand Lakes Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1860 Jh Obryan Ave, Grand Rivers, KY 42045 Phone: 703-628-2462 Fax: 270-362-9757 |