| Southern Kentucky Primary Care, P.s.c. | |
|
101 W 2nd St Russellville KY 42276 | |
| (270) 881-1813 | |
| (270) 886-6600 |
| Full Name | Southern Kentucky Primary Care, P.s.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 W 2nd St, Russellville, Kentucky |
| Authorized Official Name and Position | Latisha Edmonds (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 2702652574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Kentucky Primary Care, P.s.c. 1739 Canton St Hopkinsville KY 42240-1991 Ph: (270) 881-1813 | Southern Kentucky Primary Care, P.s.c. 101 W 2nd St Russellville KY 42276 Ph: (270) 881-1813 |
| NPI Number | 1003327412 |
|---|---|
| Provider Enumeration Date | 10/12/2017 |
| Last Update Date | 06/15/2018 |
| Medicare PECOS PAC ID | 7012274319 |
|---|---|
| Medicare Enrollment ID | O20171121002602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003327412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Kentucky) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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