Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 22055 Main St, Hyden, Kentucky |
Authorized Official Name and Position | Melissa Callahan (OFFICER/AUTHORIZED REPRESENTATIVE) |
Authorized Official Contact | 6066721978 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
22055 Main St Hyden KY 41749-8568 Ph: (606) 672-1978 | 22055 Main St Hyden KY 41749-8568 Ph: (606) 672-1978 |
NPI Number | 1255788725 |
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Provider Enumeration Date | 05/15/2016 |
Last Update Date | 10/19/2022 |
Medicare PECOS PAC ID | 0042506669 |
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Medicare Enrollment ID | O20160908000938 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255788725 | NPI | - | NPPES |
7100415020 | Medicaid | KY | |
7100422110 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (Kentucky) | Primary |
363AM0700X | Physician Assistant - Medical | PA1086 (Kentucky) | Secondary |
Provider Name | Laura G Asher |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1346404852 PECOS PAC ID: 2860521192 Enrollment ID: I20100525001054 |