Provider Demographics
NPI:1548389273
Name:LOY FAMILY PRACTICE
Entity Type:Organization
Organization Name:LOY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-864-2889
Mailing Address - Street 1:340 KEEN ST
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717
Mailing Address - Country:US
Mailing Address - Phone:270-864-2889
Mailing Address - Fax:270-864-2229
Practice Address - Street 1:340 KEEN ST
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717
Practice Address - Country:US
Practice Address - Phone:270-864-2889
Practice Address - Fax:270-864-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37436261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64060106Medicaid
KY64060106Medicaid