Provider Demographics
NPI:1205935814
Name:MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Entity type:Organization
Organization Name:MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZKALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-499-0717
Mailing Address - Street 1:148 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1496
Mailing Address - Country:US
Mailing Address - Phone:859-499-0717
Mailing Address - Fax:859-499-0926
Practice Address - Street 1:148 SKYVIEW DR.
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1300
Practice Address - Country:US
Practice Address - Phone:859-499-0717
Practice Address - Fax:859-499-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X, 261QR1300X, 363A00000X, 363LP2300X
KY207RN0300X, 363AM0700X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100636790Medicaid
KYH24904Medicare UPIN
KY65938888Medicaid