Provider Demographics
NPI:1447795299
Name:COMMUNITY FIRST HEALTH, LLC.
Entity Type:Organization
Organization Name:COMMUNITY FIRST HEALTH, LLC.
Other - Org Name:COMMUNITY FIRST EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:859-322-9984
Mailing Address - Street 1:2091 N BEND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9122
Mailing Address - Country:US
Mailing Address - Phone:859-817-1370
Mailing Address - Fax:
Practice Address - Street 1:2091 N BEND RD
Practice Address - Street 2:UNIT 100
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048
Practice Address - Country:US
Practice Address - Phone:859-817-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100481790Medicaid