Provider Demographics
NPI: | 1457719643 |
---|---|
Name: | ACK HEALTHCARE MANAGEMENT LLC |
Entity Type: | Organization |
Organization Name: | ACK HEALTHCARE MANAGEMENT LLC |
Other - Org Name: | SAINT CAMILLUS URGENT CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHUCK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | YOUNG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 270-295-3890 |
Mailing Address - Street 1: | PO BOX 1099 |
Mailing Address - Street 2: | |
Mailing Address - City: | OWENSBORO |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 42302-1099 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-277-5170 |
Mailing Address - Fax: | 502-277-5172 |
Practice Address - Street 1: | 83 BALLPARK RD |
Practice Address - Street 2: | |
Practice Address - City: | HARDINSBURG |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40143 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-580-4778 |
Practice Address - Fax: | 270-580-4779 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-02-03 |
Last Update Date: | 2019-08-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Single Specialty |