| |
126 Portman Ave Stanford KY 40484-1230 | |
(606) 365-9181 | |
(606) 365-9183 |
Full Name | |
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Speciality | Family Medicine |
Location | 126 Portman Ave, Stanford, Kentucky |
Authorized Official Name and Position | Karen Click (OFFICE MANAGER) |
Authorized Official Contact | 6063659181 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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126 Portman Ave Stanford KY 40484-1230 Ph: (606) 365-9181 | 126 Portman Ave Stanford KY 40484-1230 Ph: (606) 365-9181 |
NPI Number | 1346323383 |
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Provider Enumeration Date | 10/23/2006 |
Last Update Date | 06/21/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346323383 | NPI | - | NPPES |
65902140 | Medicaid | KY | |
7100228860 | Medicaid | KY | |
64-172208 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 17220 (Kentucky) | Primary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |