Provider Demographics
NPI:1427583178
Name:COMMONWEALTH MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:COMMONWEALTH MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-338-3958
Mailing Address - Street 1:989 GOVERNORS LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1173
Mailing Address - Country:US
Mailing Address - Phone:859-338-3958
Mailing Address - Fax:859-368-8135
Practice Address - Street 1:989 GOVERNORS LN
Practice Address - Street 2:SUITE 220
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1173
Practice Address - Country:US
Practice Address - Phone:859-338-3958
Practice Address - Fax:859-368-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty