| Waynesburg Clinic, Pllc | |
|
14098 Us Highway 27 S Waynesburg KY 40489-8253 | |
| (606) 379-6646 | |
| (606) 379-5707 |
| Full Name | Waynesburg Clinic, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14098 Us Highway 27 S, Waynesburg, Kentucky |
| Authorized Official Name and Position | Christopher Duvall Sims (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6063651547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waynesburg Clinic, Pllc Po Box 435 Waynesburg KY 40489-0435 Ph: (606) 379-6646 | Waynesburg Clinic, Pllc 14098 Us Highway 27 S Waynesburg KY 40489-8253 Ph: (606) 379-6646 |
| NPI Number | 1669670816 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 10/04/2023 |
| Medicare PECOS PAC ID | 3375635857 |
|---|---|
| Medicare Enrollment ID | O20070829000132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669670816 | NPI | - | NPPES |
| 7100019500 | Medicaid | KY | |
| 00361 | Other | KY | MEDICARE PART B |
| 183954 | Other | KY | MEDICARE PART A |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 900205 (Kentucky) | Primary |
| Provider Name | Christopher D Sims |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386687457 PECOS PAC ID: 2668440322 Enrollment ID: I20040921000088 |
| Provider Name | Samantha B Shell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518213776 PECOS PAC ID: 7911137914 Enrollment ID: I20140312001365 |
| Provider Name | Jody Coomer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962863407 PECOS PAC ID: 4880991488 Enrollment ID: I20160421000890 |
| Provider Name | Jesslyn B Kelsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346727112 PECOS PAC ID: 9537407028 Enrollment ID: I20190207001473 |
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