Provider Demographics
NPI:1851663991
Name:TLC FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:TLC FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:606-353-6926
Mailing Address - Street 1:P.O. BOX 843
Mailing Address - Street 2:
Mailing Address - City:BELFRY
Mailing Address - State:KY
Mailing Address - Zip Code:41514-7417
Mailing Address - Country:US
Mailing Address - Phone:606-353-6926
Mailing Address - Fax:606-353-6928
Practice Address - Street 1:26317 HIGHWAY 119 NORTH
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-7417
Practice Address - Country:US
Practice Address - Phone:606-353-6926
Practice Address - Fax:606-353-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7800824000Medicaid
KY7101116000Medicaid
KY7800824000Medicaid