| Westlake Primary Care Physician Group | |
|
810 Jamestown St Columbia KY 42728-1010 | |
| (270) 384-4753 | |
| Not Available |
| Full Name | Westlake Primary Care Physician Group |
|---|---|
| Speciality | Family Medicine |
| Location | 810 Jamestown St, Columbia, Kentucky |
| Authorized Official Name and Position | Rex A Tungate (CEO) |
| Authorized Official Contact | 2703844753 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Westlake Primary Care Physician Group 810 Jamestown St Columbia KY 42728-1010 Ph: (270) 384-4753 | Westlake Primary Care Physician Group 810 Jamestown St Columbia KY 42728-1010 Ph: (270) 384-4753 |
| NPI Number | 1013187228 |
|---|---|
| Provider Enumeration Date | 03/04/2008 |
| Last Update Date | 03/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013187228 | NPI | - | NPPES |
| 65909913 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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