Provider Demographics
NPI:1831131481
Name:STRAUSS FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:STRAUSS FAMILY PRACTICE, LLC
Other - Org Name:STRAUSS FAMILY PRACTICE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-392-2301
Mailing Address - Street 1:225 RICHMOND STREET
Mailing Address - Street 2:P.O. BOX 4019
Mailing Address - City:MT. VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-4019
Mailing Address - Country:US
Mailing Address - Phone:606-392-2301
Mailing Address - Fax:606-392-2304
Practice Address - Street 1:402 RICHMOND RD N
Practice Address - Street 2:SUITE B
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1133
Practice Address - Country:US
Practice Address - Phone:859-986-9521
Practice Address - Fax:859-986-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCJ2363OtherRAILROAD MEDICARE
KY35000025Medicaid
KY5764Medicare PIN
KYCJ2363OtherRAILROAD MEDICARE