Provider Demographics
NPI:1548344021
Name:LANCASTER PRIMARY CARE PSC
Entity type:Organization
Organization Name:LANCASTER PRIMARY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WERKMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-792-1797
Mailing Address - Street 1:187 FARRA DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-8764
Mailing Address - Country:US
Mailing Address - Phone:859-792-1797
Mailing Address - Fax:859-792-1793
Practice Address - Street 1:187 FARRA DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-8764
Practice Address - Country:US
Practice Address - Phone:859-792-1797
Practice Address - Fax:859-792-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65944688Medicaid
KY65944688Medicaid