Healthcare Provider Details

I. General information

NPI: 1639232127
Provider Name (Legal Business Name): ASHLAND PRIMARY CARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRAL AVE SUITE 1
ASHLAND KY
41101
US

IV. Provider business mailing address

1200 CENTRAL AVE SUITE 1
ASHLAND KY
41101
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-0977
  • Fax: 606-324-0541
Mailing address:
  • Phone: 606-329-0977
  • Fax: 606-324-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN A BOND
Title or Position: PRESIDENT
Credential: MD
Phone: 606-329-0977