Provider Demographics
NPI:1477718625
Name:TOWN FAMILY DOCTOR, PLLC
Entity Type:Organization
Organization Name:TOWN FAMILY DOCTOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VEDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEREMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-618-2472
Mailing Address - Street 1:9501 NORTON COMMONS BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7522
Mailing Address - Country:US
Mailing Address - Phone:502-618-2472
Mailing Address - Fax:502-618-2479
Practice Address - Street 1:9501 NORTON COMMONS BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7522
Practice Address - Country:US
Practice Address - Phone:502-618-2472
Practice Address - Fax:502-618-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-26
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40638261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care