Provider Demographics
NPI:1275573008
Name:FAMILY PRACTICE ASSOCIATES OF MAYSVILLE INC
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF MAYSVILLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:COMER
Authorized Official - Last Name:GALLENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-759-7878
Mailing Address - Street 1:2003 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8928
Mailing Address - Country:US
Mailing Address - Phone:606-759-7878
Mailing Address - Fax:606-759-1808
Practice Address - Street 1:2003 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8928
Practice Address - Country:US
Practice Address - Phone:606-759-7878
Practice Address - Fax:606-759-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100077000Medicaid
OH2131651Medicaid
KY7100077000Medicaid