| Integrated Wound Care Kentucky Pllc | |
|
60 Phillips Branch Rd Phelps KY 41553-9061 | |
| (718) 963-3495 | |
| Not Available |
| Full Name | Integrated Wound Care Kentucky Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 60 Phillips Branch Rd, Phelps, Kentucky |
| Authorized Official Name and Position | Diane Lusas (MEMBER) |
| Authorized Official Contact | 7189633495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Wound Care Kentucky Pllc 492c Cedar Ln Ste 514 Teaneck NJ 07666-1713 Ph: () - | Integrated Wound Care Kentucky Pllc 60 Phillips Branch Rd Phelps KY 41553-9061 Ph: (718) 963-3495 |
| NPI Number | 1144970641 |
|---|---|
| Provider Enumeration Date | 03/27/2022 |
| Last Update Date | 12/29/2022 |
| Medicare PECOS PAC ID | 7416334537 |
|---|---|
| Medicare Enrollment ID | O20220511001383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144970641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Patrick B Downs |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063432730 PECOS PAC ID: 3476597642 Enrollment ID: I20050617000741 |
| Provider Name | Shonda L Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528436334 PECOS PAC ID: 4789968819 Enrollment ID: I20190206001794 |
| Provider Name | Lawanna L Mcguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083262349 PECOS PAC ID: 3678900099 Enrollment ID: I20200225001534 |
| Provider Name | Ashley N Prater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548895535 PECOS PAC ID: 5193122018 Enrollment ID: I20210920003178 |
| Provider Name | Diane Lusas |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1730475658 PECOS PAC ID: 9032430640 Enrollment ID: I20220511001753 |
| Provider Name | Bethany Rock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235641630 PECOS PAC ID: 1850796137 Enrollment ID: I20230612002151 |
Hilltop Primary Care, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7617 Upper Johns Creek Rd, Phelps, KY 41553 Phone: 606-835-9333 Fax: 606-835-9997 |