Provider Demographics
NPI:1578578225
Name:KNOTT COUNTY FAMILY HEALTHCARE,PLLC
Entity Type:Organization
Organization Name:KNOTT COUNTY FAMILY HEALTHCARE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-785-9440
Mailing Address - Street 1:70 HOLLY HILLS MALL RD
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-9121
Mailing Address - Country:US
Mailing Address - Phone:606-785-9440
Mailing Address - Fax:606-785-9645
Practice Address - Street 1:70 HOLLY HILLS MALL RD
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822-9121
Practice Address - Country:US
Practice Address - Phone:606-785-9440
Practice Address - Fax:606-785-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900151261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001379Medicaid
KY183901Medicare Oscar/Certification
KY7394Medicare ID - Type UnspecifiedMEDICARE NUMBER