Provider Demographics
NPI:1639232127
Name:ASHLAND PRIMARY CARE PSC
Entity Type:Organization
Organization Name:ASHLAND PRIMARY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-329-0977
Mailing Address - Street 1:1200 CENTRAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-329-0977
Mailing Address - Fax:606-324-0541
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-329-0977
Practice Address - Fax:606-324-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049259OtherANTHEM
KY65931339Medicaid
KY65931339Medicaid