| Bourbon Physician Practice Llc | |
|
107 S Broadway St Carlisle KY 40311-1150 | |
| (859) 289-4124 | |
| (859) 289-4126 |
| Full Name | Bourbon Physician Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 S Broadway St, Carlisle, Kentucky |
| Authorized Official Name and Position | Monica Bowman (PRESIDENT) |
| Authorized Official Contact | 6159207000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bourbon Physician Practice Llc 107 S Broadway St Carlisle KY 40311-1150 Ph: (859) 289-4124 | Bourbon Physician Practice Llc 107 S Broadway St Carlisle KY 40311-1150 Ph: (859) 289-4124 |
| NPI Number | 1356689079 |
|---|---|
| Provider Enumeration Date | 01/30/2013 |
| Last Update Date | 09/24/2022 |
| Medicare PECOS PAC ID | 8729226097 |
|---|---|
| Medicare Enrollment ID | O20130528000124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356689079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Kentucky) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Babatunde O Sokan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346225703 PECOS PAC ID: 8628976024 Enrollment ID: I20031223000112 |
| Provider Name | Joseph G Fine |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1982601399 PECOS PAC ID: 4789571340 Enrollment ID: I20040309001111 |
| Provider Name | Nathan L Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093829822 PECOS PAC ID: 0749381275 Enrollment ID: I20070727000043 |
| Provider Name | Henry R Preston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154306207 PECOS PAC ID: 4385707496 Enrollment ID: I20090115000785 |
| Provider Name | Leslie A Asbury |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1215054556 PECOS PAC ID: 3375677867 Enrollment ID: I20100819000582 |
| Provider Name | Ashley E Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881956027 PECOS PAC ID: 9537318191 Enrollment ID: I20120926000233 |
| Provider Name | Jennifer Lynn Bond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093070914 PECOS PAC ID: 6204072960 Enrollment ID: I20130424001057 |
| Provider Name | Jose A Lopez-gonzalez |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1396701694 PECOS PAC ID: 4284600644 Enrollment ID: I20130917000513 |
| Provider Name | Seth T Fritz |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1831539212 PECOS PAC ID: 2860621075 Enrollment ID: I20140211001273 |
| Provider Name | Stacey M Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013300896 PECOS PAC ID: 6800115916 Enrollment ID: I20150511002525 |
| Provider Name | Mahmoud A Abualayem |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1659703163 PECOS PAC ID: 2567755432 Enrollment ID: I20160729001469 |
| Provider Name | Christina Maria Chaney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265810402 PECOS PAC ID: 9931476926 Enrollment ID: I20170523000914 |
| Provider Name | Dawne M Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629449517 PECOS PAC ID: 9436459575 Enrollment ID: I20170711001537 |
| Provider Name | Taffany Norton Amburgey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265998280 PECOS PAC ID: 6901146125 Enrollment ID: I20190325002143 |
| Provider Name | Regina Maria Raab |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851443378 PECOS PAC ID: 4981926961 Enrollment ID: I20190408001422 |
| Provider Name | Lauren L Crump |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811508831 PECOS PAC ID: 5698191765 Enrollment ID: I20200819003542 |
| Provider Name | John S Reece |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316936412 PECOS PAC ID: 3476502469 Enrollment ID: I20201118000850 |
| Provider Name | Brent Hillard |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1215399431 PECOS PAC ID: 2062782022 Enrollment ID: I20210712003240 |
| Provider Name | Daniel Jay Tinney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780329110 PECOS PAC ID: 1456734359 Enrollment ID: I20220810000153 |
| Provider Name | Heather Leanne Lemaster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508567363 PECOS PAC ID: 0749647808 Enrollment ID: I20230605001837 |
| Provider Name | Timothy Lee Morgan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407315732 PECOS PAC ID: 9032445671 Enrollment ID: I20240821002611 |
Jmhc Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2330 Concrete Rd, Carlisle, KY 40311 Phone: 859-289-2212 Fax: 859-289-7510 | |
Sterling Health Solutions Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 133 School Dr, Carlisle, KY 40311 Phone: 859-404-7686 Fax: 859-498-8160 | |
Harrison Memorial Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 254 E Main St, Carlisle, KY 40311 Phone: 859-289-6311 Fax: 859-235-3699 | |
Carlisle Clinic, Psc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 S Broadway St, Carlisle, KY 40311 Phone: 859-289-4124 Fax: 859-289-4126 | |
Sterling Health Solutions Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1355 Concrete Rd, Carlisle, KY 40311 Phone: 859-405-4024 Fax: 859-405-4026 | |
Licking Valley Internal Medicine & Pediatrics Psc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 254 E Main St, Carlisle, KY 40311 Phone: 859-289-6311 Fax: 859-289-3366 |