MEDICARE: LILY CREEK MEDICAL GROUP, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	363L00000X	Nurse Practitioner
3	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000064586	OTHER	KY	ANTHEM
2	608475500	OTHER	KY	BLACK LUNG
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205987542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILY CREEK MEDICAL GROUP, PSC

Provider Business Mailing Address
First Line	:	PO BOX 5007
Second Line	:
City	:	FRANKFORT
State	:	KY
Zip	:	40602-5007
Country	:	US
Telephone Number	:	502-226-3858
Fax Number	:	502-223-9829

Provider Business Practice Location Address
First Line	:	92 JOE T PETTY DR
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-8543
Country	:	US
Telephone Number	:	270-866-8881
Fax Number	:	270-866-8849

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT L. BERTRAM
Credential	:	D.O.
Telephone Number	:	270-866-8881

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	10/30/2008

Similar Medicare Providers

1215938733 — COLUMBIA MEDICAL EQUIPMENT, INC.
Practice Location Address:

92 JOE T PETTY DR , SUITE 700
RUSSELL SPRINGS, KY
42642-8543

Practice Phone: 270-866-6994
Practice Fax: 270-866-7011

1700857414 — DR. MILES KENTON GIBSON M.D.
Practice Location Address:

92 JOE T PETTY DR , SUITE 300
RUSSELL SPRINGS, KY
42642-8543

Practice Phone: 270-866-7066
Practice Fax: 270-866-7068

1992718084 — LAKER DRUG INC.
Practice Location Address:

92 JOE T PETTY DR
RUSSELL SPRINGS, KY
42642-8543

Practice Phone: 270-866-7787
Practice Fax:

1477630879 — COMMONWEALTH UROLOGY RUSSELL SPRINGS
Practice Location Address:

92 JOE T PETTY DR
RUSSELL SPRINGS, KY
42642-8543

Practice Phone: 859-236-9670
Practice Fax:

1417008756 — ROBERT L. BERTRAM D.O.
Practice Location Address:

92 JOE T PETTY DR
RUSSELL SPRINGS, KY
42642-8543

Practice Phone: 270-866-8881
Practice Fax: 270-866-8849

1245875798 — ABIGAIL PLOCH RD
Practice Location Address:

4501 SPICEWOOD SPRINGS RD STE 1022
AUSTIN, TX
78759-8543

Practice Phone: 512-257-0898
Practice Fax:

Directions to “LILY CREEK MEDICAL GROUP, PSC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.