| Kentuckycare 63 | |
|
110 Kings Dr Mayfield KY 42066-3602 | |
| (270) 804-7710 | |
| (270) 804-7722 |
| Full Name | Kentuckycare 63 |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 Kings Dr, Mayfield, Kentucky |
| Authorized Official Name and Position | Steven Collier (CEO) |
| Authorized Official Contact | 8703472534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentuckycare 63 Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | Kentuckycare 63 110 Kings Dr Mayfield KY 42066-3602 Ph: (270) 804-7710 |
| NPI Number | 1194263236 |
|---|---|
| Provider Enumeration Date | 02/09/2017 |
| Last Update Date | 03/09/2023 |
| Certification Date | 03/09/2023 |
| Medicare PECOS PAC ID | 2567370620 |
|---|---|
| Medicare Enrollment ID | O20170417001732 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194263236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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