| Letek Pllc | |
|
942 W Main St Unit B Mount Vernon KY 40456-2523 | |
| (731) 571-9223 | |
| (931) 901-1239 |
| Full Name | Letek Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 942 W Main St Unit B, Mount Vernon, Kentucky |
| Authorized Official Name and Position | Thomas William Fowles (OWNER) |
| Authorized Official Contact | 8593583069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Letek Pllc 942 W Main St Unit B Mount Vernon KY 40456-2523 Ph: (731) 571-9223 | Letek Pllc 942 W Main St Unit B Mount Vernon KY 40456-2523 Ph: (731) 571-9223 |
| NPI Number | 1043766801 |
|---|---|
| Provider Enumeration Date | 08/31/2016 |
| Last Update Date | 03/06/2021 |
| Medicare PECOS PAC ID | 3476835570 |
|---|---|
| Medicare Enrollment ID | O20170125002448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043766801 | NPI | - | NPPES |
| 64102726 | Medicaid | KY | |
| 7846668 | Other | KY | AETNA PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 38140 (Kentucky) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 38140 (Kentucky) | Primary |
| Provider Name | Thomas W Fowles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285679100 PECOS PAC ID: 7810928058 Enrollment ID: I20050826000495 |
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