| Southfork Medical Clinic Pllc | |
|
57 Medical Lane Whitley City KY 42653 | |
| (606) 376-7211 | |
| (606) 376-9219 |
| Full Name | Southfork Medical Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 57 Medical Lane, Whitley City, Kentucky |
| Authorized Official Name and Position | Virginia Ann Correll (CREDENTIALING) |
| Authorized Official Contact | 6063767212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southfork Medical Clinic Pllc Po Box 490 Whitley City KY 42653-0490 Ph: (606) 376-7211 | Southfork Medical Clinic Pllc 57 Medical Lane Whitley City KY 42653 Ph: (606) 376-7211 |
| NPI Number | 1205616265 |
|---|---|
| Provider Enumeration Date | 10/05/2023 |
| Last Update Date | 04/15/2024 |
| Medicare PECOS PAC ID | 7012815616 |
|---|---|
| Medicare Enrollment ID | O20240614001045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205616265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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