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1293 N Main St Ste 102 Monticello KY 42633-1945 | |
(606) 340-8825 | |
(606) 340-0097 |
Full Name | |
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Speciality | Family Medicine |
Location | 1293 N Main St Ste 102, Monticello, Kentucky |
Authorized Official Name and Position | Walter F Koscienski (PRESIDENT) |
Authorized Official Contact | 6063408825 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1293 N Main St Ste 102 Monticello KY 42633-1945 Ph: (606) 340-8825 | 1293 N Main St Ste 102 Monticello KY 42633-1945 Ph: (606) 340-8825 |
NPI Number | 1134322670 |
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Provider Enumeration Date | 06/11/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134322670 | NPI | - | NPPES |
65935819 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (Kentucky) | Primary |