Provider Demographics
NPI:1972056661
Name:MOUNT OLIVET PRIMARY CARE
Entity Type:Organization
Organization Name:MOUNT OLIVET PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A C
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-234-3282
Mailing Address - Street 1:420 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVET
Mailing Address - State:KY
Mailing Address - Zip Code:41064
Mailing Address - Country:US
Mailing Address - Phone:606-584-8666
Mailing Address - Fax:859-234-9400
Practice Address - Street 1:430 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1816
Practice Address - Country:US
Practice Address - Phone:859-234-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A. C. WRIGHT PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty