Provider Demographics
NPI:1447758669
Name:SELECT PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:SELECT PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-940-8576
Mailing Address - Street 1:1341 NATURAL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SLADE
Mailing Address - State:KY
Mailing Address - Zip Code:40376-9014
Mailing Address - Country:US
Mailing Address - Phone:606-521-6298
Mailing Address - Fax:
Practice Address - Street 1:1341 NATURAL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SLADE
Practice Address - State:KY
Practice Address - Zip Code:40376-9014
Practice Address - Country:US
Practice Address - Phone:606-521-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty