Provider Demographics
NPI:1689732448
Name:HAROLD PRIMAY CARE
Entity Type:Organization
Organization Name:HAROLD PRIMAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-478-8787
Mailing Address - Street 1:265 OLD HAROLD RD
Mailing Address - Street 2:
Mailing Address - City:HAROLD
Mailing Address - State:KY
Mailing Address - Zip Code:41635-9036
Mailing Address - Country:US
Mailing Address - Phone:606-478-8787
Mailing Address - Fax:
Practice Address - Street 1:265 OLD HAROLD RD
Practice Address - Street 2:
Practice Address - City:HAROLD
Practice Address - State:KY
Practice Address - Zip Code:41635-9036
Practice Address - Country:US
Practice Address - Phone:606-478-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64324650Medicaid
KY78001898Medicaid
KYF89450Medicare UPIN
KY0367803Medicare ID - Type UnspecifiedWILMA LESLIE, FCNP
KY78001898Medicaid
KY572168Medicare UPIN