Provider Demographics
NPI:1124471370
Name:FAMILY CENTER LLC
Entity type:Organization
Organization Name:FAMILY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAIRLENA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-439-3399
Mailing Address - Street 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9483
Mailing Address - Country:US
Mailing Address - Phone:606-439-3399
Mailing Address - Fax:606-487-9280
Practice Address - Street 1:101 TOWN AND COUNTRY LANE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-3399
Practice Address - Fax:606-487-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty