Provider Demographics
NPI:1821084971
Name:RED BIRD CLINIC, INC.
Entity Type:Organization
Organization Name:RED BIRD CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-3155
Mailing Address - Street 1:53 QUEENDALE CENTER
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEVERLY
Mailing Address - State:KY
Mailing Address - Zip Code:40913
Mailing Address - Country:US
Mailing Address - Phone:606-598-5135
Mailing Address - Fax:606-598-3151
Practice Address - Street 1:53 QUEENDALE CENTER
Practice Address - Street 2:SUITE 1
Practice Address - City:BEVERLY
Practice Address - State:KY
Practice Address - Zip Code:40913
Practice Address - Country:US
Practice Address - Phone:606-598-5135
Practice Address - Fax:606-598-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000227Medicaid
KY2061Medicare PIN
KY183864Medicare Oscar/Certification