Provider Demographics
NPI:1306823141
Name:CENTER FOR FAMILY CARE
Entity Type:Organization
Organization Name:CENTER FOR FAMILY CARE
Other - Org Name:LOGAN MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTICIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:270-265-5010
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:118 SOUTH MAIN STREET
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-0895
Mailing Address - Country:US
Mailing Address - Phone:270-265-5040
Mailing Address - Fax:270-265-5235
Practice Address - Street 1:118 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-0895
Practice Address - Country:US
Practice Address - Phone:270-265-5040
Practice Address - Fax:270-265-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900022261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001114Medicaid
KY35001114Medicaid