Healthcare Provider Details

I. General information

NPI: 1447405865
Provider Name (Legal Business Name): FAMILY HEALTH CARE ASSOCIATES RURAL CLINIC OF CORBIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2886 UK KY HWY 1629 SUITE 3
CORBIN KY
40701-2739
US

IV. Provider business mailing address

PO BOX 1535
BARBOURVILLE KY
40906-7300
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-7777
  • Fax: 606-545-7611
Mailing address:
  • Phone: 606-546-7777
  • Fax: 606-545-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40244
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. GINA GOOD
Title or Position: OWNER
Credential: APRN
Phone: 606-546-7777