Provider Demographics
NPI:1346323383
Name:PHYSICIANS FOR FAMILIES PSC
Entity type:Organization
Organization Name:PHYSICIANS FOR FAMILIES PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-365-9181
Mailing Address - Street 1:126 PORTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1230
Mailing Address - Country:US
Mailing Address - Phone:606-365-9181
Mailing Address - Fax:606-365-9183
Practice Address - Street 1:126 PORTMAN AVE
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1230
Practice Address - Country:US
Practice Address - Phone:606-365-9181
Practice Address - Fax:606-365-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17220207Q00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65902140Medicaid
KY7100228860Medicaid
KY64-172208Medicaid
KY=========OtherEIN
KY64-172208Medicaid