Provider Demographics
NPI:1275271066
Name:DOCTORS HOUSE CALL, PA
Entity Type:Organization
Organization Name:DOCTORS HOUSE CALL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FARREL
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-309-2559
Mailing Address - Street 1:295 E HWY 50 STE 5
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2576
Mailing Address - Country:US
Mailing Address - Phone:575-309-2559
Mailing Address - Fax:888-803-4502
Practice Address - Street 1:1320 CURRY ROAD I
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9509
Practice Address - Country:US
Practice Address - Phone:575-309-2559
Practice Address - Fax:888-803-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care