Provider Demographics
NPI:1851054597
Name:KENTUCKY FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:KENTUCKY FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-878-1219
Mailing Address - Street 1:195 COMMERCIAL DR STE 98
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-5200
Mailing Address - Country:US
Mailing Address - Phone:606-878-1219
Mailing Address - Fax:
Practice Address - Street 1:195 COMMERCIAL DR STE 98
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-5200
Practice Address - Country:US
Practice Address - Phone:606-878-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health