Provider Demographics
NPI:1104892181
Name:KENTUCKY FAMILY CARE PSC
Entity type:Organization
Organization Name:KENTUCKY FAMILY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:T
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-679-9213
Mailing Address - Street 1:298 BOGLE ST
Mailing Address - Street 2:STE B
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-679-9213
Mailing Address - Fax:606-677-9963
Practice Address - Street 1:298 BOGLE ST
Practice Address - Street 2:STE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2836
Practice Address - Country:US
Practice Address - Phone:606-679-9213
Practice Address - Fax:606-677-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65931008Medicaid
KY5715Medicare PIN
KYC70971Medicare UPIN