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35 Joshua Ln Hawesville KY 42348-3500 | |
(270) 922-1000 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 35 Joshua Ln, Hawesville, Kentucky |
Authorized Official Name and Position | Crystal Lee Hinton (PROVIDER ENROLLMENT SPECIALIST) |
Authorized Official Contact | 8127720589 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8885 State Road 237 Tell City IN 47586-8567 Ph: (812) 772-0589 | 35 Joshua Ln Hawesville KY 42348-3500 Ph: (270) 922-1000 |
NPI Number | 1801637343 |
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Provider Enumeration Date | 06/06/2024 |
Last Update Date | 06/27/2024 |
Medicare PECOS PAC ID | 6901871276 |
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Medicare Enrollment ID | O20240927003045 |
Identifier | Type | State | Issuer |
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1801637343 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Provider Name | Megan Brockman |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629528252 PECOS PAC ID: 7719261486 Enrollment ID: I20210316000444 |
Complete Wellness Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 25 Joshua Lane, Hawesville, KY 42348 Phone: 270-927-1000 Fax: 270-927-1077 | |