Provider Demographics
NPI:1295563765
Name:PHELPS MEDICAL
Entity type:Organization
Organization Name:PHELPS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-307-3918
Mailing Address - Street 1:115 TRADEPARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3428
Mailing Address - Country:US
Mailing Address - Phone:606-307-3918
Mailing Address - Fax:
Practice Address - Street 1:115 TRADEPARK DR STE B
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3428
Practice Address - Country:US
Practice Address - Phone:606-307-3918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care