Provider Demographics
NPI:1316920663
Name:MT. STERLING CLINIC, PLLC.
Entity type:Organization
Organization Name:MT. STERLING CLINIC, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-498-0200
Mailing Address - Street 1:100 STERLING WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT. STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-498-0200
Mailing Address - Fax:859-498-5812
Practice Address - Street 1:100 STERLING WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MT. STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353
Practice Address - Country:US
Practice Address - Phone:859-498-0200
Practice Address - Fax:859-498-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65937849Medicaid
KY65937849Medicaid
KYD92245Medicare UPIN