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1907 E Pittsburg Church Rd London KY 40741-9047 | |
(606) 389-5269 | |
(606) 389-5276 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1907 E Pittsburg Church Rd, London, Kentucky |
Authorized Official Name and Position | Stephanie Ann Short (OWNER/CEO) |
Authorized Official Contact | 6063895269 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1907 E Pittsburg Church Rd London KY 40741-9047 Ph: (606) 389-5269 | 1907 E Pittsburg Church Rd London KY 40741-9047 Ph: (606) 389-5269 |
NPI Number | 1609634377 |
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Provider Enumeration Date | 03/07/2024 |
Last Update Date | 06/03/2024 |
Medicare PECOS PAC ID | 2163803255 |
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Medicare Enrollment ID | O20240509003898 |
Identifier | Type | State | Issuer |
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1609634377 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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