Provider Demographics
NPI:1043399249
Name:SCOTTSVILLE PRIMARY CARE CLINIC
Entity Type:Organization
Organization Name:SCOTTSVILLE PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT REGISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-239-9355
Mailing Address - Street 1:217 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1122
Mailing Address - Country:US
Mailing Address - Phone:270-239-9355
Mailing Address - Fax:270-239-9356
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1122
Practice Address - Country:US
Practice Address - Phone:270-239-9355
Practice Address - Fax:270-239-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1920P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7757Medicare ID - Type UnspecifiedPRACTICE ID