Provider Demographics
NPI:1457468969
Name:REGIONAL PHYSICIANS CORPORATION II
Entity Type:Organization
Organization Name:REGIONAL PHYSICIANS CORPORATION II
Other - Org Name:CLARK IMMEDIATE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:FRARACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-745-3500
Mailing Address - Street 1:PO BOX 4140
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-4140
Mailing Address - Country:US
Mailing Address - Phone:859-745-6471
Mailing Address - Fax:859-744-0257
Practice Address - Street 1:1934 BYPASS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2389
Practice Address - Country:US
Practice Address - Phone:859-745-1160
Practice Address - Fax:859-745-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700085261QU0200X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65943011Medicaid
KY65943011Medicaid