Provider Demographics
NPI:1780381210
Name:WEST CARTER MEDICAL CARE
Entity type:Organization
Organization Name:WEST CARTER MEDICAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIEARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-939-8756
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-0780
Mailing Address - Country:US
Mailing Address - Phone:606-939-8756
Mailing Address - Fax:
Practice Address - Street 1:151 W TOM T HALL BLVD
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164
Practice Address - Country:US
Practice Address - Phone:606-939-8756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty