Healthcare Provider Details

I. General information

NPI: 1831131481
Provider Name (Legal Business Name): STRAUSS FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 RICHMOND RD N SUITE B
BEREA KY
40403-1133
US

IV. Provider business mailing address

225 RICHMOND STREET P.O. BOX 4019
MT. VERNON KY
40456-4019
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-9521
  • Fax: 859-986-7369
Mailing address:
  • Phone: 606-392-2301
  • Fax: 606-392-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON M STRAUSS
Title or Position: OWNER
Credential: MD
Phone: 606-392-2301