Provider Demographics
NPI:1598963910
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:DR
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:606-768-9180
Practice Address - Street 1:125 FOXGLOVE DR
Practice Address - Street 2:SUITE D
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9735
Practice Address - Country:US
Practice Address - Phone:859-498-3333
Practice Address - Fax:859-498-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700182261QP2300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH73481Medicare UPIN