Vip Community Health Llc | |
503 Humston Dr Lawrenceburg KY 40342-1927 | |
(270) 543-7557 | |
Not Available |
Full Name | Vip Community Health Llc |
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Speciality | Clinic/Center |
Location | 503 Humston Dr, Lawrenceburg, Kentucky |
Authorized Official Name and Position | Debra Hardison (OWNER) |
Authorized Official Contact | 2705437557 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Vip Community Health Llc 3064 Pea Ridge Rd Waddy KY 40076-6107 Ph: (270) 543-7557 | Vip Community Health Llc 503 Humston Dr Lawrenceburg KY 40342-1927 Ph: (270) 543-7557 |
NPI Number | 1568152098 |
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Provider Enumeration Date | 05/09/2023 |
Last Update Date | 06/29/2023 |
Medicare PECOS PAC ID | 7618339326 |
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Medicare Enrollment ID | O20230811003031 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568152098 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Barry G Hardison |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1225039258 PECOS PAC ID: 4880697713 Enrollment ID: I20081108000052 |
Provider Name | Debra L Hardison |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851922744 PECOS PAC ID: 8426460239 Enrollment ID: I20201221001543 |
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