Provider Demographics
NPI:1376188276
Name:HEALTHCORE FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:HEALTHCORE FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-619-5488
Mailing Address - Street 1:107 BROADBILL CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9294
Mailing Address - Country:US
Mailing Address - Phone:859-619-5488
Mailing Address - Fax:502-570-9269
Practice Address - Street 1:103 BOSTON SQ
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9746
Practice Address - Country:US
Practice Address - Phone:859-619-5488
Practice Address - Fax:502-570-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100243400Medicaid