Provider Demographics
NPI:1417261280
Name:ABUNDANT LIVING MEDICAL CLINIC
Entity Type:Organization
Organization Name:ABUNDANT LIVING MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-263-4900
Mailing Address - Street 1:3100 OLD TODDS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-5006
Mailing Address - Country:US
Mailing Address - Phone:859-263-4900
Mailing Address - Fax:
Practice Address - Street 1:3100 OLD TODDS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-5006
Practice Address - Country:US
Practice Address - Phone:859-263-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center