Healthcare Provider Details

I. General information

NPI: 1821084971
Provider Name (Legal Business Name): RED BIRD CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 QUEENDALE CENTER SUITE 1
BEVERLY KY
40913
US

IV. Provider business mailing address

53 QUEENDALE CENTER SUITE 1
BEVERLY KY
40913
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-5135
  • Fax: 606-598-5131
Mailing address:
  • Phone: 606-598-5135
  • Fax: 606-598-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARI COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-598-3155