Provider Demographics
NPI:1013035419
Name:TAYLOR COUNTY FAMILY PRACTICE PSC
Entity Type:Organization
Organization Name:TAYLOR COUNTY FAMILY PRACTICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZTENDERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-465-4841
Mailing Address - Street 1:407 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1836
Mailing Address - Country:US
Mailing Address - Phone:270-465-4841
Mailing Address - Fax:270-465-0120
Practice Address - Street 1:407 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1837
Practice Address - Country:US
Practice Address - Phone:270-465-4841
Practice Address - Fax:270-465-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26865207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6811Medicare PIN