Provider Demographics
NPI:1417324252
Name:PENDLETON FAMILY CARE
Entity Type:Organization
Organization Name:PENDLETON FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:SR
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-629-6333
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0906
Mailing Address - Country:US
Mailing Address - Phone:270-678-6333
Mailing Address - Fax:270-678-7333
Practice Address - Street 1:1412 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3473
Practice Address - Country:US
Practice Address - Phone:270-629-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty