Provider Demographics
NPI:1881659951
Name:FAMILY MEDICAL CENTER OF HART CO
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER OF HART CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-524-7231
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765
Mailing Address - Country:US
Mailing Address - Phone:270-524-7231
Mailing Address - Fax:270-524-7415
Practice Address - Street 1:117 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765
Practice Address - Country:US
Practice Address - Phone:270-524-7231
Practice Address - Fax:270-524-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208000000X, 208100000X
KY900144261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100157220Medicaid
KY1064168OtherPASSPORT MEDICAID MGD CAR
KY35001346Medicaid
KY000000057825OtherANTHEM GROUP
KYK007193OtherCHAMPUS TRICARE GROUP
KYCF7880OtherRAILROAD MEDICARE UNITED
KY4674OtherOLD ANTHEM GROUP
KY4674OtherOLD ANTHEM GROUP
KY000000057825OtherANTHEM GROUP