Provider Demographics
NPI:1912604448
Name:AUDUBON AREA COMMUNITY CARE CLINIC, INC.
Entity type:Organization
Organization Name:AUDUBON AREA COMMUNITY CARE CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:KAAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-686-6040
Mailing Address - Street 1:PO BOX 1874
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1874
Mailing Address - Country:US
Mailing Address - Phone:270-686-6040
Mailing Address - Fax:270-686-6050
Practice Address - Street 1:1620 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4807
Practice Address - Country:US
Practice Address - Phone:270-686-6040
Practice Address - Fax:270-686-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)