| Personal Geri-care Psc | |
|
150 W Bear Track Rd Campbellsville KY 42718-8709 | |
| (270) 465-8133 | |
| (270) 789-1543 |
| Full Name | Personal Geri-care Psc |
|---|---|
| Speciality | Family Medicine |
| Location | 150 W Bear Track Rd, Campbellsville, Kentucky |
| Authorized Official Name and Position | Jeffrey Lynn Dixon (OFFICE MANAGER) |
| Authorized Official Contact | 2704651535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Personal Geri-care Psc 150 W Bear Track Rd Campbellsville KY 42718-8709 Ph: (270) 465-8133 | Personal Geri-care Psc 150 W Bear Track Rd Campbellsville KY 42718-8709 Ph: (270) 465-8133 |
| NPI Number | 1710559463 |
|---|---|
| Provider Enumeration Date | 07/13/2021 |
| Last Update Date | 07/13/2021 |
| Medicare PECOS PAC ID | 7911303623 |
|---|---|
| Medicare Enrollment ID | O20210903001946 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710559463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Jerome A Dixon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215919451 PECOS PAC ID: 5799744363 Enrollment ID: I20041008000353 |
| Provider Name | Kevin A Graves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164765582 PECOS PAC ID: 2668601824 Enrollment ID: I20140210001625 |
| Provider Name | Lori Ann Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235695677 PECOS PAC ID: 5193068005 Enrollment ID: I20190516001617 |
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