Provider Demographics
NPI:1750317491
Name:FLAT LICK MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:FLAT LICK MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TALMADGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-542-5900
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:FLAT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40935-0346
Mailing Address - Country:US
Mailing Address - Phone:606-542-5900
Mailing Address - Fax:
Practice Address - Street 1:34 MARY ALICE DR
Practice Address - Street 2:
Practice Address - City:FLAT LICK
Practice Address - State:KY
Practice Address - Zip Code:40935-6164
Practice Address - Country:US
Practice Address - Phone:606-542-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14797174400000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001338Medicaid
KY35001338Medicaid
KY9765Medicare PIN
KY183896Medicare Oscar/Certification