Full Name | |
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Speciality | Clinic/Center |
Location | 11134 Ky-191, Hazel Green, Kentucky |
Authorized Official Name and Position | Derrick J Hamilton (CEO) |
Authorized Official Contact | 6066669950 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 690 Beattyville KY 41311-0690 Ph: (606) 464-0151 | 11134 Ky-191 Hazel Green KY 41332 Ph: (606) 464-0151 |
NPI Number | 1609654276 |
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Provider Enumeration Date | 09/15/2023 |
Last Update Date | 07/16/2024 |
Medicare PECOS PAC ID | 2961453618 |
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Medicare Enrollment ID | O20231227002161 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609654276 | NPI | - | NPPES |
31000862 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |