| Prospect Internal Medicine | |
|
9537 Us Highway 42 Prospect KY 40059-9301 | |
| (502) 713-1332 | |
| (502) 713-1218 |
| Full Name | Prospect Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 9537 Us Highway 42, Prospect, Kentucky |
| Authorized Official Name and Position | Tina Yuan (OWNER) |
| Authorized Official Contact | 5027131332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect Internal Medicine Po Box 319 Prospect KY 40059-0319 Ph: (502) 713-1332 | Prospect Internal Medicine 9537 Us Highway 42 Prospect KY 40059-9301 Ph: (502) 713-1332 |
| NPI Number | 1033597828 |
|---|---|
| Provider Enumeration Date | 05/12/2015 |
| Last Update Date | 05/06/2022 |
| Certification Date | 05/06/2022 |
| Medicare PECOS PAC ID | 7810200730 |
|---|---|
| Medicare Enrollment ID | O20150722003726 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033597828 | NPI | - | NPPES |
| 50091760 | Other | KY | PASSPORT HEALTH PLAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Tina T Yuan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295758514 PECOS PAC ID: 0840256418 Enrollment ID: I20041206000445 |
| Provider Name | Katherine P Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477036994 PECOS PAC ID: 2163774928 Enrollment ID: I20181008000104 |
| Provider Name | Samantha Claybern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639729312 PECOS PAC ID: 9436578945 Enrollment ID: I20201002001298 |
| Provider Name | Allyson Riggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720691470 PECOS PAC ID: 1759701428 Enrollment ID: I20201019001580 |
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