Provider Demographics
NPI:1265294003
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:MOUNT 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 1:1011 BRANDY LN STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8441
Practice Address - Country:US
Practice Address - Phone:859-286-7555
Practice Address - Fax:859-661-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100960720Medicaid
KY7100963540Medicaid
KY7100981520Medicaid
KY7100961550Medicaid
KY7100966960Medicaid