Provider Demographics
NPI:1306020326
Name:FAMILY MEDICAL C ENTER OF HART COUNTY
Entity Type:Organization
Organization Name:FAMILY MEDICAL C ENTER OF HART COUNTY
Other - Org Name:FAMILY MEDICAL CENTER OF HART COUNTY NON-RHC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-524-7231
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-0579
Mailing Address - Country:US
Mailing Address - Phone:270-524-7231
Mailing Address - Fax:270-524-7415
Practice Address - Street 1:205 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8900
Practice Address - Country:US
Practice Address - Phone:270-524-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY MEDICAL CENTER OF HART COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100197650OtherMEDICAID- PHYSICIAN OFFICE
K007193OtherCHAMPUS-TRICARE
KY1064127OtherPASSPORT-SPECIALTIST GROUP
1064168OtherPASSPORT
KY000000057825OtherANTHEM
KY7100120170OtherMEDICAID- PHYSICAL THERAPY GROUP
CF7880OtherRAILROAD MEDICARE
KY65904476Medicaid
KY65904476Medicaid