Provider Demographics
NPI:1063450781
Name:FAMILY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESICENT, CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-789-2424
Mailing Address - Street 1:824 FM STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1252
Mailing Address - Country:US
Mailing Address - Phone:606-789-2424
Mailing Address - Fax:606-789-2492
Practice Address - Street 1:824 FM STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1252
Practice Address - Country:US
Practice Address - Phone:606-789-2424
Practice Address - Fax:606-789-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940199Medicaid
KY700135OtherPRIMARY CARE CENTER LICEN
KY700135OtherPRIMARY CARE CENTER LICEN