Provider Demographics
NPI:1598531535
Name:FAITH HEALTHCARE, INC.
Entity Type:Organization
Organization Name:FAITH HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-425-5768
Mailing Address - Street 1:521 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-9503
Mailing Address - Country:US
Mailing Address - Phone:066-425-5768
Mailing Address - Fax:606-425-5769
Practice Address - Street 1:107 METKER TRL STE A
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1049
Practice Address - Country:US
Practice Address - Phone:606-365-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty