Provider Demographics
NPI:1619258498
Name:FYI HEALTHCARE CLINIC, PLLC
Entity Type:Organization
Organization Name:FYI HEALTHCARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-274-0638
Mailing Address - Street 1:1219 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8955
Mailing Address - Country:US
Mailing Address - Phone:270-274-0638
Mailing Address - Fax:270-274-5600
Practice Address - Street 1:1219 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8955
Practice Address - Country:US
Practice Address - Phone:270-274-0638
Practice Address - Fax:270-274-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY133942083X0100X
KY3003830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty