Provider Demographics
NPI:1972568376
Name:BULLITT COUNTY FAMILY CARE CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:BULLITT COUNTY FAMILY CARE CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:INGWERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-955-5200
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-1169
Mailing Address - Country:US
Mailing Address - Phone:502-955-5200
Mailing Address - Fax:502-526-5581
Practice Address - Street 1:1578 HIGHWAY 44 E
Practice Address - Street 2:SUITE 2
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7172
Practice Address - Country:US
Practice Address - Phone:502-955-5200
Practice Address - Fax:502-526-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32033173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG86619Medicare UPIN
KY0769501Medicare ID - Type Unspecified