Provider Demographics
NPI:1700395654
Name:ACK HEALTHCARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:ACK HEALTHCARE MANAGEMENT LLC
Other - Org Name:ST. CAMILLUS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-489-0862
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1099
Mailing Address - Country:US
Mailing Address - Phone:502-277-5170
Mailing Address - Fax:502-277-5172
Practice Address - Street 1:312 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754
Practice Address - Country:US
Practice Address - Phone:270-287-0087
Practice Address - Fax:270-287-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty