Provider Demographics
NPI:1124665807
Name:MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Entity type:Organization
Organization Name:MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZKALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-499-0717
Mailing Address - Street 1:148 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1496
Mailing Address - Country:US
Mailing Address - Phone:859-499-0717
Mailing Address - Fax:859-499-0926
Practice Address - Street 1:1145 W LEXINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1290
Practice Address - Country:US
Practice Address - Phone:859-744-0301
Practice Address - Fax:859-744-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100977320Medicaid