| White House Clinic | |
|
30 Stacy Lane Road Irvine KY 40336 | |
| (606) 723-0665 | |
| Not Available |
| Full Name | White House Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 Stacy Lane Road, Irvine, Kentucky |
| Authorized Official Name and Position | Jenny Sargent (CREDENTIALER) |
| Authorized Official Contact | 8596267700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White House Clinic 1010 Main St South Mc Kee KY 40447-7089 Ph: (606) 287-7104 | White House Clinic 30 Stacy Lane Road Irvine KY 40336 Ph: (606) 723-0665 |
| NPI Number | 1427283647 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 07/17/2018 |
| Medicare PECOS PAC ID | 8224946561 |
|---|---|
| Medicare Enrollment ID | O20091005000229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427283647 | NPI | - | NPPES |
| 31000243 | Medicaid | KY | |
| 01439 | Other | KY | MEDICARE ADMINISTAR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700030 (Kentucky) | Primary |
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