MEDICARE: FAITH HEALTHCARE INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1790541431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HEALTHCARE INC

Provider Business Mailing Address
First Line	:	521 CRANE RD
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-9503
Country	:	US
Telephone Number	:	606-425-5768
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 RICHMOND ST
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2712
Country	:	US
Telephone Number	:	606-331-5720
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	LOGAN ROY ANTLE
Credential	:
Telephone Number	:	606-425-5768

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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Directions to “FAITH HEALTHCARE INC ” Practice Location

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