Provider Demographics
NPI:1417624586
Name:FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-371-0378
Mailing Address - Street 1:68 PAULEY HOLW
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41527-8349
Mailing Address - Country:US
Mailing Address - Phone:606-371-0378
Mailing Address - Fax:
Practice Address - Street 1:306 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4023
Practice Address - Country:US
Practice Address - Phone:606-237-1000
Practice Address - Fax:606-237-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty