Provider Demographics
NPI:1407071954
Name:ARVIN FAMILY PRACTICE P.S.C.
Entity Type:Organization
Organization Name:ARVIN FAMILY PRACTICE P.S.C.
Other - Org Name:JON ANTHONY ARVIN M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-256-2143
Mailing Address - Street 1:185 NEWCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2733
Mailing Address - Country:US
Mailing Address - Phone:606-256-2143
Mailing Address - Fax:606-256-9762
Practice Address - Street 1:185 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2733
Practice Address - Country:US
Practice Address - Phone:606-256-2143
Practice Address - Fax:606-256-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33743208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64337439Medicaid
KY65905895Medicaid
KY65905895Medicaid
KY64337439Medicaid