Provider Demographics
NPI:1902856123
Name:SHEPHERDSVILLE FAMILY HEALTH CLINIC, PSC
Entity Type:Organization
Organization Name:SHEPHERDSVILLE FAMILY HEALTH CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHEICH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-921-1231
Mailing Address - Street 1:181 HIGHWAY 44 E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6081
Mailing Address - Country:US
Mailing Address - Phone:502-921-1231
Mailing Address - Fax:502-921-1275
Practice Address - Street 1:181 HIGHWAY 44 E
Practice Address - Street 2:SUITE 1
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6081
Practice Address - Country:US
Practice Address - Phone:502-921-1231
Practice Address - Fax:502-921-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001999Medicaid