Provider Demographics
NPI:1033217559
Name:MEDICAL POINT OF CARE PLLC
Entity Type:Organization
Organization Name:MEDICAL POINT OF CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-787-8888
Mailing Address - Street 1:112 LIBERTY SQ
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539
Mailing Address - Country:US
Mailing Address - Phone:606-787-8888
Mailing Address - Fax:606-787-1414
Practice Address - Street 1:112 LIBERTY SQ
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-8888
Practice Address - Fax:606-787-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940090Medicaid
KYDA9975OtherRAILROAD MEDICARE
KY000000312356OtherBC
KY7928Medicare ID - Type UnspecifiedGROUP #