Provider Demographics
NPI:1689971970
Name:FAITH MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:FAITH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-546-2511
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-1404
Mailing Address - Country:US
Mailing Address - Phone:606-546-2511
Mailing Address - Fax:606-546-2513
Practice Address - Street 1:13232 N HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-4972
Practice Address - Country:US
Practice Address - Phone:606-627-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02875207Q00000X
KY3008480363L00000X
KY1119255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty