Provider Demographics
NPI:1881844926
Name:CADIZ FAMILY CARE CLINIC, LLC
Entity Type:Organization
Organization Name:CADIZ FAMILY CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-522-9696
Mailing Address - Street 1:261 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-6125
Mailing Address - Country:US
Mailing Address - Phone:270-522-9697
Mailing Address - Fax:270-522-9698
Practice Address - Street 1:261 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-6125
Practice Address - Country:US
Practice Address - Phone:270-522-9697
Practice Address - Fax:270-522-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64312085Medicaid