Provider Demographics
NPI:1518302892
Name:COMMUNITY FAMILY CLINIC PLLC
Entity Type:Organization
Organization Name:COMMUNITY FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAUFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-768-9190
Mailing Address - Street 1:784 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:FRENCHBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40322-8123
Mailing Address - Country:US
Mailing Address - Phone:606-768-9190
Mailing Address - Fax:
Practice Address - Street 1:17 MILLER DRIVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-2212
Practice Address - Country:US
Practice Address - Phone:606-674-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100263730Medicaid
KY7100263730Medicaid
KY188928Medicare PIN