| Licking Valley Internal Medicine & Pediatrics Psc | |
|
1210 Ky Highway 36 E Suite 2a Cynthiana KY 41031-7490 | |
| (859) 234-9611 | |
| (859) 235-0878 |
| Full Name | Licking Valley Internal Medicine & Pediatrics Psc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1210 Ky Highway 36 E, Cynthiana, Kentucky |
| Authorized Official Name and Position | William Frank Mckemie (PRESIDENT) |
| Authorized Official Contact | 8592349611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Licking Valley Internal Medicine & Pediatrics Psc 1210 Ky Highway 36 E Suite 2a Cynthiana KY 41031-7490 Ph: (859) 234-9611 | Licking Valley Internal Medicine & Pediatrics Psc 1210 Ky Highway 36 E Suite 2a Cynthiana KY 41031-7490 Ph: (859) 234-9611 |
| NPI Number | 1225136153 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 04/07/2010 |
| Medicare PECOS PAC ID | 3678463379 |
|---|---|
| Medicare Enrollment ID | O20040317000532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225136153 | NPI | - | NPPES |
| 65934341 | Medicaid | KY |
| Provider Name | Stephen A Besson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750344552 PECOS PAC ID: 1850329210 Enrollment ID: I20080102000343 |
| Provider Name | Sarah Lindsey Florence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124250089 PECOS PAC ID: 3971640954 Enrollment ID: I20091023000218 |
| Provider Name | Misti S. Dixon Mcnees |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922551142 PECOS PAC ID: 2961796958 Enrollment ID: I20160815001315 |
| Provider Name | James O Calder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447667332 PECOS PAC ID: 0244545788 Enrollment ID: I20180830003707 |
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