Provider Demographics
NPI:1831177955
Name:ALBERTSON FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:ALBERTSON FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-527-0045
Mailing Address - Street 1:543 POWELL LANE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5366
Mailing Address - Country:US
Mailing Address - Phone:270-527-0045
Mailing Address - Fax:270-527-0075
Practice Address - Street 1:543 POWELL LANE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5366
Practice Address - Country:US
Practice Address - Phone:270-527-0045
Practice Address - Fax:270-527-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941890Medicaid
KY9278Medicare ID - Type Unspecified