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1 S Creek Dr Ste 102 Monticello KY 42633-9472 | |
(606) 348-3365 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1 S Creek Dr Ste 102, Monticello, Kentucky |
Authorized Official Name and Position | Robert Parmelee (CEO) |
Authorized Official Contact | 6063483365 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1 S Creek Dr Ste 102 Monticello KY 42633-9472 Ph: (606) 348-3365 | 1 S Creek Dr Ste 102 Monticello KY 42633-9472 Ph: (606) 348-3365 |
NPI Number | 1063007672 |
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Provider Enumeration Date | 03/05/2021 |
Last Update Date | 10/24/2024 |
Medicare PECOS PAC ID | 2062409154 |
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Medicare Enrollment ID | O20040429000965 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063007672 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Sheryl E Polk |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578554978 PECOS PAC ID: 9436192200 Enrollment ID: I20050603000079 |
Provider Name | Barry White |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609879758 PECOS PAC ID: 1850369679 Enrollment ID: I20070328000053 |
Provider Name | Bonnie Stockton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659327591 PECOS PAC ID: 6103953609 Enrollment ID: I20100414000644 |
Provider Name | Sherrell L Roberts |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1780675801 PECOS PAC ID: 6103018163 Enrollment ID: I20101008000363 |
Provider Name | Peter Petrenko |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1770574147 PECOS PAC ID: 0446442446 Enrollment ID: I20101008000783 |
Provider Name | Yanire Martinez |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1093705311 PECOS PAC ID: 0941494132 Enrollment ID: I20101102000108 |
Provider Name | Mark Anthony Roark |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518380625 PECOS PAC ID: 2466675699 Enrollment ID: I20140515001631 |
Provider Name | Carl Don Coffey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861811093 PECOS PAC ID: 7719100684 Enrollment ID: I20140521001723 |
Provider Name | Matthew Eaton |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336494772 PECOS PAC ID: 7315230745 Enrollment ID: I20160722001510 |
Provider Name | Jacob Dudley Coffey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194232207 PECOS PAC ID: 0244594109 Enrollment ID: I20180501002823 |
Provider Name | Raymond Bennett Speck |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063992956 PECOS PAC ID: 2668723776 Enrollment ID: I20180927002877 |
Provider Name | Misty Gail Atkinson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619647658 PECOS PAC ID: 9133508724 Enrollment ID: I20220628003088 |
Provider Name | Pamela R. Hancock |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285347112 PECOS PAC ID: 2163883760 Enrollment ID: I20230728003193 |