Provider Demographics
NPI:1427082338
Name:COMMUNITY FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:COMMUNITY FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAUFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-768-9190
Mailing Address - Street 1:784 HWY 36
Mailing Address - Street 2:
Mailing Address - City:FRENCHBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40322-8123
Mailing Address - Country:US
Mailing Address - Phone:606-768-9190
Mailing Address - Fax:606-768-9180
Practice Address - Street 1:784 HWY 36
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-8123
Practice Address - Country:US
Practice Address - Phone:606-768-9190
Practice Address - Fax:606-768-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36974207Q00000X, 363L00000X
207R00000X, 363LF0000X
KY700182261QP2300X
KY900200261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183949OtherRURAL HEALTH MEDICARE
KY35002021Medicaid
KY65945198Medicaid
KY64055361Medicaid
KY7100010420Medicaid
KY11493417OtherCAQH
KY7100000960Medicaid
KY7100010230Medicaid
KY7100010230Medicaid
KY11493417OtherCAQH
KY7100010420Medicaid
KY7100010230Medicaid
KY183949Medicare PIN
BK7849663OtherDEA
KY7100000960Medicaid