Provider Demographics
NPI:1003583717
Name:COMMONWEALTH FAMILY CLINIC, PLLC
Entity type:Organization
Organization Name:COMMONWEALTH FAMILY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-457-1864
Mailing Address - Street 1:1890 STAR SHOOT PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4567
Mailing Address - Country:US
Mailing Address - Phone:859-457-1864
Mailing Address - Fax:
Practice Address - Street 1:2387 PROFESSIONAL HEIGHTS DR STE 60
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3004
Practice Address - Country:US
Practice Address - Phone:859-303-8756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine