Provider Demographics
NPI:1699725234
Name:CAREFIRST URGENT CARE CENTER LLC
Entity type:Organization
Organization Name:CAREFIRST URGENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:D
Authorized Official - Last Name:KINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-706-1900
Mailing Address - Street 1:1111 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4900
Mailing Address - Country:US
Mailing Address - Phone:270-706-1023
Mailing Address - Fax:270-706-1167
Practice Address - Street 1:1111 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4900
Practice Address - Country:US
Practice Address - Phone:270-706-1111
Practice Address - Fax:270-706-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932170Medicaid
KY6112Medicare ID - Type Unspecified