Provider Demographics
NPI:1013192376
Name:INDEPENDENCE FAMILY PRACTICE P S C
Entity Type:Organization
Organization Name:INDEPENDENCE FAMILY PRACTICE P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:ALLNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-363-8600
Mailing Address - Street 1:5290 MADISON PIKE
Mailing Address - Street 2:STE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051
Mailing Address - Country:US
Mailing Address - Phone:859-363-8600
Mailing Address - Fax:859-960-0003
Practice Address - Street 1:5290 MADISON PIKE
Practice Address - Street 2:STE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051
Practice Address - Country:US
Practice Address - Phone:859-363-8600
Practice Address - Fax:859-960-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000370204OtherANTHEM
0973601Medicare PIN
KYC70711Medicare UPIN