Provider Demographics
NPI:1356490338
Name:WOODFORD FAMILY PHYSICIANS, PSC
Entity Type:Organization
Organization Name:WOODFORD FAMILY PHYSICIANS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:859-873-9188
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-0049
Mailing Address - Country:US
Mailing Address - Phone:859-873-9188
Mailing Address - Fax:859-873-0870
Practice Address - Street 1:360 AMSDEN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1851
Practice Address - Country:US
Practice Address - Phone:859-873-9188
Practice Address - Fax:859-873-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933640Medicaid
KY1883Medicare ID - Type UnspecifiedGROUP ID