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160 Cave St Monticello KY 42633-1412 | |
(844) 435-0900 | |
(270) 858-4029 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 160 Cave St, Monticello, Kentucky |
Authorized Official Name and Position | Eric E Loy (CEO) |
Authorized Official Contact | 2708641472 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1080 Burkesville KY 42717-1080 Ph: (270) 864-1472 | 160 Cave St Monticello KY 42633-1412 Ph: (844) 435-0900 |
NPI Number | 1487037941 |
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Provider Enumeration Date | 07/02/2015 |
Last Update Date | 10/27/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487037941 | NPI | - | NPPES |
700172 | Other | KY | STATE LICENSE |
7100017280 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700172 (Kentucky) | Primary |