Healthcare Provider Details

I. General information

NPI: 1588690259
Provider Name (Legal Business Name): CARLISLE CLINIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S BROADWAY ST
CARLISLE KY
40311-1150
US

IV. Provider business mailing address

107 S BROADWAY ST
CARLISLE KY
40311-1150
US

V. Phone/Fax

Practice location:
  • Phone: 859-289-4124
  • Fax: 859-289-4126
Mailing address:
  • Phone: 859-289-4124
  • Fax: 859-289-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900162
License Number StateKY

VIII. Authorized Official

Name: JANET TAMAREN
Title or Position: OWNER
Credential: M.D.
Phone: 859-289-4124