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2161 Lexington Rd Richmond KY 40475-7952 | |
(859) 626-7794 | |
(859) 626-7764 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2161 Lexington Rd, Richmond, Kentucky |
Authorized Official Name and Position | Reba M. Bowling (OWNER CEO) |
Authorized Official Contact | 8596267794 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2161 Lexington Rd First Floor, Suite 5 Richmond KY 40475-7952 Ph: (859) 626-7794 | 2161 Lexington Rd Richmond KY 40475-7952 Ph: (859) 626-7794 |
NPI Number | 1891799177 |
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Provider Enumeration Date | 06/02/2005 |
Last Update Date | 07/09/2020 |
Medicare PECOS PAC ID | 5698749216 |
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Medicare Enrollment ID | O20040820000358 |
Identifier | Type | State | Issuer |
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1891799177 | NPI | - | NPPES |
35001775 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 900185 (Kentucky) | Primary |
Provider Name | Kimberly H Sowden |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1376686105 PECOS PAC ID: 5092815704 Enrollment ID: I20070711000067 |
Provider Name | Isela Lopez |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841077716 PECOS PAC ID: 0143676676 Enrollment ID: I20231019002344 |
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