Provider Demographics
NPI:1770573800
Name:FAMILY MEDICINE ASSOCIATES OF FLEMINGSBURG, PSC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF FLEMINGSBURG, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-849-3374
Mailing Address - Street 1:932 ELIZAVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-9209
Mailing Address - Country:US
Mailing Address - Phone:606-849-3374
Mailing Address - Fax:606-845-0646
Practice Address - Street 1:932 ELIZAVILLE AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9209
Practice Address - Country:US
Practice Address - Phone:606-849-3374
Practice Address - Fax:606-845-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207Q00000X
KY1089188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65918971Medicaid
KYCM5205OtherRAILROAD MEDICARE
KY65918971Medicaid