FAMILY MEDICAL SPECIALTY CLINIC PLLC NPI 1992863021

NPI Information

NPI: 1992863021
Provider Name: FAMILY MEDICAL SPECIALTY CLINIC PLLC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 18D1003602

Address:
12 JACKSON HEIGHTS DRIVE
FAMILY MEDICAL & SPECIALTY CLINIC, LLC
JACKSON, KY
ZIP 41339
Phone: (606) 693-0199
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FAMILY MEDICAL SPECIALTY CLINIC PLLC is a rural health clinic center in Jackson, KY. FAMILY MEDICAL SPECIALTY CLINIC PLLC NPI is 1992863021. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

12 JACKSON HEIGHTS DRIVE
FAMILY MEDICAL & SPECIALTY CLINIC, LLC
JACKSON, KY
ZIP 41339
Phone: (606) 693-0199
Fax: (606) 666-9480

The provider's authorized official is June E Abadilla .
The authorized official title is President and has the following contact phone number (606) 693-0199.

The CLIA number assigned to this NPI record is 18D1003602 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/4/2006 and was last updated on 9/25/2022.

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	207R00000X	Internal Medicine				No
2	261QR1300X	Clinic/Center	Rural Health			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	31000904	MEDICAID	KENTUCKY

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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