| Thacker Family Medical Llc | |
|
140 Adams Ln Suite 600-700 Pikeville KY 41501-3087 | |
| (606) 509-2000 | |
| (606) 509-2002 |
| Full Name | Thacker Family Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 140 Adams Ln, Pikeville, Kentucky |
| Authorized Official Name and Position | Chadward L. Thacker (SOILE MEMBER/OWNER) |
| Authorized Official Contact | 6065092000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thacker Family Medical Llc Po Box 1228 140 Adams Lane, Suite 600-700 Pikeville KY 41502-1228 Ph: (606) 509-2000 | Thacker Family Medical Llc 140 Adams Ln Suite 600-700 Pikeville KY 41501-3087 Ph: (606) 509-2000 |
| NPI Number | 1629342985 |
|---|---|
| Provider Enumeration Date | 03/05/2012 |
| Last Update Date | 04/11/2017 |
| Medicare PECOS PAC ID | 1557523057 |
|---|---|
| Medicare Enrollment ID | O20120430000202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629342985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 38711 (Kentucky) | Primary |
| Provider Name | Chadward L Thacker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801811542 PECOS PAC ID: 2264480003 Enrollment ID: I20050107000473 |
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