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1719 Nashville St Ste C Russellville KY 42276-7804 | |
| (270) 726-7664 | |
| (270) 726-9997 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1719 Nashville St Ste C, Russellville, Kentucky |
| Authorized Official Name and Position | Michele Lawless (EXECUTIVE VICE PRESIDENT & CFO) |
| Authorized Official Contact | 2707451500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
800 Park St Bowling Green KY 42101-2347 Ph: (270) 745-1500 | 1719 Nashville St Ste C Russellville KY 42276-7804 Ph: (270) 726-7664 |
| NPI Number | 1760228647 |
|---|---|
| Provider Enumeration Date | 07/01/2024 |
| Last Update Date | 07/24/2024 |
| Medicare PECOS PAC ID | 7719899947 |
|---|---|
| Medicare Enrollment ID | O20240919000258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760228647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Patrick K Hayden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295847184 PECOS PAC ID: 5799756102 Enrollment ID: I20040802000131 |
| Provider Name | Janie E Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699762690 PECOS PAC ID: 2961546981 Enrollment ID: I20100215000386 |
| Provider Name | Nomathamsanqa Moyo-peters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811336423 PECOS PAC ID: 7113214248 Enrollment ID: I20200924002193 |
| Provider Name | Erinn Lynn Basista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457954471 PECOS PAC ID: 3678986981 Enrollment ID: I20210105003292 |
| Provider Name | Leslie Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568162592 PECOS PAC ID: 9638543986 Enrollment ID: I20230328001300 |
Southern Kentucky Primary Care, P.s.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 101 W 2nd St, Russellville, KY 42276 Phone: 270-881-1813 Fax: 270-886-6600 | |
Great Physician Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 975 Hopkinsville Rd, Russellville, KY 42276 Phone: 270-726-9568 Fax: 270-726-9570 | |
Singh Medical Associates, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1405 Nashville St, Russellville, KY 42276 Phone: 270-725-9700 Fax: 270-783-3751 | |
Logan Family Practice Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1719 Nashville St, Russellville, KY 42276 Phone: 270-726-7664 | |
Community Health Centers Of Western Kentucky Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1497 Nashville Road, Russellville, KY 42276 Phone: 270-726-1266 Fax: 270-726-1961 | |
Lawrence Joseph Gotts Do Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1621 S Nashville St, Suite 104, Russellville, KY 42276 Phone: 270-726-4444 Fax: 270-726-4400 |