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45 Indian Mill Rd Park City KY 42160-7724 | |
(270) 749-5665 | |
(270) 858-4029 |
Full Name | |
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Speciality | Clinic/Center |
Location | 45 Indian Mill Rd, Park City, Kentucky |
Authorized Official Name and Position | Eric E Loy (CEO) |
Authorized Official Contact | 2708586655 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1080 Burkesville KY 42717-1080 Ph: (270) 858-6655 | 45 Indian Mill Rd Park City KY 42160-7724 Ph: (270) 749-5665 |
NPI Number | 1689219453 |
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Provider Enumeration Date | 11/15/2019 |
Last Update Date | 12/12/2019 |
Medicare PECOS PAC ID | 6305947789 |
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Medicare Enrollment ID | O20200305001026 |
Identifier | Type | State | Issuer |
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1689219453 | NPI | - | NPPES |
7100017280 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |