Provider Demographics
NPI:1053300681
Name:FAMILY PHYSICIAN ASSOCIATES PSC
Entity Type:Organization
Organization Name:FAMILY PHYSICIAN ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-633-3525
Mailing Address - Street 1:515 HOSPITAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1619
Mailing Address - Country:US
Mailing Address - Phone:502-633-3525
Mailing Address - Fax:502-633-3825
Practice Address - Street 1:515 HOSPITAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1619
Practice Address - Country:US
Practice Address - Phone:502-633-3525
Practice Address - Fax:502-633-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1054303OtherPASSPORT
KY65900011Medicaid
0993Medicare ID - Type Unspecified
KY1054303OtherPASSPORT