Provider Demographics
NPI:1366626566
Name:MAGOFFIN SOUTH CLINIC
Entity Type:Organization
Organization Name:MAGOFFIN SOUTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTIE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:SALYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-349-6212
Mailing Address - Street 1:723 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-9740
Mailing Address - Country:US
Mailing Address - Phone:606-349-6212
Mailing Address - Fax:606-349-6216
Practice Address - Street 1:HC 88 BOX 180
Practice Address - Street 2:
Practice Address - City:GUNLOCK
Practice Address - State:KY
Practice Address - Zip Code:41632-9701
Practice Address - Country:US
Practice Address - Phone:606-349-8242
Practice Address - Fax:606-884-5000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGOFFIN COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY15000722OtherHANDS
KY000000059385OtherBLUE CROSS BLUE SHIELD
KY15000722OtherHANDS