Provider Demographics
NPI:1447430731
Name:MCCLEEREY FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:MCCLEEREY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCCLEEREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-234-1010
Mailing Address - Street 1:100 HELMWOOD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2975
Mailing Address - Country:US
Mailing Address - Phone:270-234-1010
Mailing Address - Fax:270-234-0105
Practice Address - Street 1:100 HELMWOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2975
Practice Address - Country:US
Practice Address - Phone:270-234-1010
Practice Address - Fax:270-234-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41138261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00593001Medicare PIN