Provider Demographics
NPI:1811182777
Name:FAMILY MEDICAL CLINIC, PSC
Entity type:Organization
Organization Name:FAMILY MEDICAL CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-598-9595
Mailing Address - Street 1:1100 BROOKHAVEN RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-2745
Mailing Address - Country:US
Mailing Address - Phone:270-598-9595
Mailing Address - Fax:270-598-9590
Practice Address - Street 1:1100 BROOKHAVEN RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2745
Practice Address - Country:US
Practice Address - Phone:270-598-9595
Practice Address - Fax:270-598-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64029887Medicaid
KY0525116Medicare PIN
KY64029887Medicaid