MEDICARE: FAMILY CARE CLINIC, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	900143	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285655167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE CLINIC, PLLC

Provider Business Mailing Address
First Line	:	644 MAYSVILLE RD
Second Line	:	SUITE 8
City	:	MT STERLING
State	:	KY
Zip	:	40353-9464
Country	:	US
Telephone Number	:	859-498-6006
Fax Number	:	859-498-8006

Provider Business Practice Location Address
First Line	:	644 MAYSVILLE RD
Second Line	:	SUITE 8
City	:	MT STERLING
State	:	KY
Zip	:	40353-9464
Country	:	US
Telephone Number	:	859-498-6006
Fax Number	:	859-498-8006

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRENDA JEAN DRENNEN
Credential	:	ARNP
Telephone Number	:	859-498-6006

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	10/07/2008

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