Provider Demographics
NPI:1841024809
Name:ROCKY TOP FAMILY MED, INC.
Entity type:Organization
Organization Name:ROCKY TOP FAMILY MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-335-2140
Mailing Address - Street 1:139 REPASS RD
Mailing Address - Street 2:
Mailing Address - City:MOORESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37811-5520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 NOLAND ROAD
Practice Address - Street 2:
Practice Address - City:MORRESBURG
Practice Address - State:TN
Practice Address - Zip Code:37811
Practice Address - Country:US
Practice Address - Phone:606-335-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health