GEORGETOWN MEDICAL LLC NPI 1063824381

NPI Information

NPI: 1063824381
Provider Name: GEORGETOWN MEDICAL, LLC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 18D2119759

Address:
105 EASTSIDE DR
GEORGETOWN, KY
ZIP 40324
Phone: (502) 868-0664
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GEORGETOWN MEDICAL, LLC is a methadone clinic center in Georgetown, KY. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. GEORGETOWN MEDICAL, LLC NPI is 1063824381. The provider is registered as an organization entity type.

The provider's business location address is:

105 EASTSIDE DR
GEORGETOWN, KY
ZIP 40324-797
Phone: (502) 868-0664

The provider's authorized official is Robyn Tanis .
The authorized official title is Executive Director Of Contract Mgmt and has the following contact phone number (856) 533-8762.

The CLIA number assigned to this NPI record is 18D2119759 - other - alcohol and drug treatmen with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/21/2014 and was last updated on 9/9/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM2800X	Clinic/Center	Methadone	810355	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	810355	OTHER	KENTUCKY	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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