Provider Demographics
NPI:1104282482
Name:WEBB PRIMARY CARE LLC
Entity type:Organization
Organization Name:WEBB PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-253-3003
Mailing Address - Street 1:419 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1631
Mailing Address - Country:US
Mailing Address - Phone:606-253-3003
Mailing Address - Fax:606-253-3002
Practice Address - Street 1:419 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1631
Practice Address - Country:US
Practice Address - Phone:606-253-3003
Practice Address - Fax:606-253-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008661261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY363LA2200XOtherCOVENTRY CARES
KY202470645OtherANTHEM KY MEDICAID
KY363LA2200XOtherHUMANA CARESOURCE
KY000000911648OtherANTHEM BCBS
KY363LA2200XOtherWELLCARE
KY363LA2200XOtherCGS ADMINISTRATORS, LLC
KY363LA2200XMedicaid
KY202470645OtherAETNA
KY202470645OtherPASSPORT