Provider Demographics
NPI:1992832695
Name:KNOX FAMILY MEDICINE
Entity Type:Organization
Organization Name:KNOX FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-546-6027
Mailing Address - Street 1:602 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1304
Mailing Address - Country:US
Mailing Address - Phone:606-546-6027
Mailing Address - Fax:606-546-2084
Practice Address - Street 1:602 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1304
Practice Address - Country:US
Practice Address - Phone:606-546-6027
Practice Address - Fax:606-546-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87900551Medicaid
KY87900551Medicaid