Provider Demographics
NPI:1275694168
Name:CARROLL COUNTY MEDICAL ADVISORS LP
Entity Type:Organization
Organization Name:CARROLL COUNTY MEDICAL ADVISORS LP
Other - Org Name:CARROLL COUNTY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:HILLEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-732-3275
Mailing Address - Street 1:309 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008
Mailing Address - Country:US
Mailing Address - Phone:502-732-4321
Mailing Address - Fax:502-732-3289
Practice Address - Street 1:309 11TH STREET
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008
Practice Address - Country:US
Practice Address - Phone:502-732-4321
Practice Address - Fax:502-732-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183985Medicare ID - Type UnspecifiedPROVIDER