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1102 S Main St London KY 40741-1529 | |
(606) 770-5121 | |
(606) 770-5199 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1102 S Main St, London, Kentucky |
Authorized Official Name and Position | Reagen Loughran (OWNER/MEMBER) |
Authorized Official Contact | 6068628917 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1102 S Main St London KY 40741-1529 Ph: (606) 770-5121 | 1102 S Main St London KY 40741-1529 Ph: (606) 770-5121 |
NPI Number | 1821482118 |
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Provider Enumeration Date | 03/24/2015 |
Last Update Date | 08/29/2022 |
Medicare PECOS PAC ID | 6305150954 |
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Medicare Enrollment ID | O20150727002968 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821482118 | NPI | - | NPPES |
B0-3893 | Other | KY | CMS CERT# FOR RURAL HEALTH CLINIC DESIGNATION |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Carla R Phelps |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629080148 PECOS PAC ID: 4587612239 Enrollment ID: I20050110000273 |
Provider Name | Reagen M Loughran |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821277518 PECOS PAC ID: 1759466410 Enrollment ID: I20080306000030 |
Provider Name | Stephanie Short |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1154728251 PECOS PAC ID: 9436405867 Enrollment ID: I20180627002114 |
Provider Name | Teresa Smith |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275126617 PECOS PAC ID: 9234537820 Enrollment ID: I20230727002701 |
Provider Name | Judy Carol Bailey |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1396430641 PECOS PAC ID: 3870944242 Enrollment ID: I20240110001817 |
Provider Name | Consondra D Loughran |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1780009704 PECOS PAC ID: 2668844853 Enrollment ID: I20240410003197 |
Provider Name | Stephen George Sigrimis |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255966172 PECOS PAC ID: 4981044401 Enrollment ID: I20240501002780 |
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