Provider Demographics
NPI:1871655985
Name:FLAGET HEALTHCARE INC
Entity Type:Organization
Organization Name:FLAGET HEALTHCARE INC
Other - Org Name:FLAGET IMMEDIATE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-350-5000
Mailing Address - Street 1:PO BOX 1160
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-4160
Mailing Address - Country:US
Mailing Address - Phone:502-348-3400
Mailing Address - Fax:502-350-5022
Practice Address - Street 1:110 S SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1761
Practice Address - Country:US
Practice Address - Phone:502-348-3400
Practice Address - Fax:502-350-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35000645Medicaid
KY50018276OtherPASSPORT HEALTH PLAN
KY35000645Medicaid