Provider Demographics
NPI:1578896080
Name:DR. PHYLLIS D. CORBITT PSC
Entity Type:Organization
Organization Name:DR. PHYLLIS D. CORBITT PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORBITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-858-3219
Mailing Address - Street 1:317 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1323
Mailing Address - Country:US
Mailing Address - Phone:859-858-3219
Mailing Address - Fax:859-858-3940
Practice Address - Street 1:317 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1323
Practice Address - Country:US
Practice Address - Phone:859-858-3219
Practice Address - Fax:859-858-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C69523Medicare UPIN
KY1019001Medicare PIN