Provider Demographics
NPI:1366003550
Name:BROCK MEDICAL, LLC
Entity Type:Organization
Organization Name:BROCK MEDICAL, LLC
Other - Org Name:FIRST CARE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-600-3478
Mailing Address - Street 1:PO BOX 5802
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 W JOHN ROWAN BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2663
Practice Address - Country:US
Practice Address - Phone:606-716-6017
Practice Address - Fax:606-261-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health