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310 College St Lakeside Bldg Barbourville KY 40906-1410 | |
| (972) 367-4845 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 310 College St, Barbourville, Kentucky |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5050 Spring Valley Rd. Dallas TX 75244-3909 Ph: () - | 310 College St Lakeside Bldg Barbourville KY 40906-1410 Ph: (972) 367-4845 |
| NPI Number | 1851830509 |
|---|---|
| Provider Enumeration Date | 02/14/2017 |
| Last Update Date | 02/14/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851830509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25858 (Kentucky) | Primary |
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