Provider Demographics
NPI:1679243919
Name:MCQUEARY FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:MCQUEARY FAMILY MEDICINE INC
Other - Org Name:MCQUEARY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-465-0191
Mailing Address - Street 1:410 HOTCHKISS ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1340
Mailing Address - Country:US
Mailing Address - Phone:270-465-0191
Mailing Address - Fax:270-465-0463
Practice Address - Street 1:410 HOTCHKISS ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1340
Practice Address - Country:US
Practice Address - Phone:270-465-0191
Practice Address - Fax:270-465-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty