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1219 W Main St West Liberty KY 41472-2161 | |
| (606) 743-4808 | |
| (606) 743-4716 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1219 W Main St, West Liberty, Kentucky |
| Authorized Official Name and Position | Derrick J Hamilton (CEO) |
| Authorized Official Contact | 6064640151 |
| 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) 743-4808 | 1219 W Main St West Liberty KY 41472-2161 Ph: (606) 743-4808 |
| NPI Number | 1447791512 |
|---|---|
| Provider Enumeration Date | 03/09/2017 |
| Last Update Date | 01/05/2022 |
| Medicare PECOS PAC ID | 2961453618 |
|---|---|
| Medicare Enrollment ID | O20170524000658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447791512 | NPI | - | NPPES |
| 31000862 | Medicaid | KY | |
| 181022 | Other | KY | MEDICARE FQHS |
| 9521 | Other | KY | CGS MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Kentucky) | Primary |
Faith Family Practice Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 N. Main Str., West Liberty, KY 41472 Phone: 606-743-1422 Fax: 606-743-3044 | |
Frederick Medical Clinic Psc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 430 Liberty Rd, West Liberty, KY 41472 Phone: 606-743-3114 Fax: 606-743-1404 | |
United Clinics Of Kentucky Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 633 Prestonsburg St, West Liberty, KY 41472 Phone: 606-743-3477 | |