SOUTH SHORE FAMILY MEDICAL CLINIC NPI 1497232722

NPI Information

NPI: 1497232722
Provider Name: SOUTH SHORE FAMILY MEDICAL CLINIC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 18D2095629

Address:
74 BIGGS LN
SOUTH SHORE, KY
ZIP 41175
Phone: (606) 498-4232
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SOUTH SHORE FAMILY MEDICAL CLINIC is a family nurse practitioner in South Shore, KY. SOUTH SHORE FAMILY MEDICAL CLINIC NPI is 1497232722. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

74 BIGGS LN
SOUTH SHORE, KY
ZIP 41175-846
Phone: (606) 498-4232

The provider's authorized official is James Lee Ryan .
The authorized official title is Fnp and has the following contact phone number (606) 498-4232.

The CLIA number assigned to this NPI record is 18D2095629 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/19/2018 and was last updated on 7/19/2018.

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	363LF0000X	Nurse Practitioner	Family	3006463	KENTUCKY	Yes

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

NPI Synchronization or Removal

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