| Yahweh Medical Clinic Psc | |
|
3513 Cumberland Ave Middlesboro KY 40965-2611 | |
| (631) 790-2862 | |
| Not Available |
| Full Name | Yahweh Medical Clinic Psc |
|---|---|
| Speciality | General Practice |
| Location | 3513 Cumberland Ave, Middlesboro, Kentucky |
| Authorized Official Name and Position | Asher Gabriel (OWNER) |
| Authorized Official Contact | 6317902862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yahweh Medical Clinic Psc 3589 Highway 33 S New Tazewell TN 37825-2319 Ph: (631) 790-2862 | Yahweh Medical Clinic Psc 3513 Cumberland Ave Middlesboro KY 40965-2611 Ph: (631) 790-2862 |
| NPI Number | 1497309827 |
|---|---|
| Provider Enumeration Date | 07/24/2019 |
| Last Update Date | 09/19/2019 |
| Medicare PECOS PAC ID | 4587994280 |
|---|---|
| Medicare Enrollment ID | O20190923003360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497309827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Michelle L Broughton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053540674 PECOS PAC ID: 5799831343 Enrollment ID: I20090923000175 |
| Provider Name | Asher A Gabriel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588864326 PECOS PAC ID: 6406142256 Enrollment ID: I20170428001596 |
| Provider Name | Jennifer Lucille Hensley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104485630 PECOS PAC ID: 2961732417 Enrollment ID: I20190925002641 |
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