Provider Demographics
NPI:1720215767
Name:ENCLAVE FAMILY HEALTHCARE, PLC
Entity Type:Organization
Organization Name:ENCLAVE FAMILY HEALTHCARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MBA
Authorized Official - Phone:370-314-4394
Mailing Address - Street 1:3500 VILLA PT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7825
Mailing Address - Country:US
Mailing Address - Phone:270-685-3722
Mailing Address - Fax:270-777-9283
Practice Address - Street 1:3500 VILLA PT
Practice Address - Street 2:SUITE 110
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7825
Practice Address - Country:US
Practice Address - Phone:270-685-3722
Practice Address - Fax:270-777-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YM0800X, 363LF0000X
KY017076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty