| Advanced Family Medical Clinic Liberty | |
|
84 Hustonville St Liberty KY 42539-3456 | |
| (859) 691-0201 | |
| Not Available |
| Full Name | Advanced Family Medical Clinic Liberty |
|---|---|
| Speciality | Clinic/Center |
| Location | 84 Hustonville St, Liberty, Kentucky |
| Authorized Official Name and Position | Khursheed Akram Siddiqui (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8596910201 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Family Medical Clinic Liberty Po Box 2369 Danville KY 40423-2369 Ph: (606) 303-9011 | Advanced Family Medical Clinic Liberty 84 Hustonville St Liberty KY 42539-3456 Ph: (859) 691-0201 |
| NPI Number | 1023545241 |
|---|---|
| Provider Enumeration Date | 05/18/2017 |
| Last Update Date | 04/20/2023 |
| Medicare PECOS PAC ID | 3173891926 |
|---|---|
| Medicare Enrollment ID | O20170620000387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023545241 | NPI | - | NPPES |
| 65942906 | Medicaid | KY | |
| 7100503210 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 28741 (Kentucky) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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