Provider Demographics
NPI:1285655167
Name:FAMILY CARE CLINIC, PLLC
Entity Type:Organization
Organization Name:FAMILY CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DRENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:859-498-6006
Mailing Address - Street 1:644 MAYSVILLE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9464
Mailing Address - Country:US
Mailing Address - Phone:859-498-6006
Mailing Address - Fax:859-498-8006
Practice Address - Street 1:644 MAYSVILLE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9464
Practice Address - Country:US
Practice Address - Phone:859-498-6006
Practice Address - Fax:859-498-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900143261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001411Medicaid
KY35001411Medicaid
KY=========OtherTAX ID COMMERCIAL INSURAN
KY183902Medicare Oscar/Certification