Provider Demographics
NPI:1992863021
Name:FAMILY MEDICAL SPECIALTY CLINIC PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL SPECIALTY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-693-0199
Mailing Address - Street 1:12 JACKSON HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339
Mailing Address - Country:US
Mailing Address - Phone:606-693-0199
Mailing Address - Fax:606-666-9480
Practice Address - Street 1:12 JACKSON HEIGHTS DRIVE
Practice Address - Street 2:FAMILY MEDICAL & SPECIALTY CLINIC, LLC
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339
Practice Address - Country:US
Practice Address - Phone:606-693-0199
Practice Address - Fax:606-666-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000904Medicaid
KY31000904Medicaid