Healthcare Provider Details

I. General information

NPI: 1023691813
Provider Name (Legal Business Name): REAL HEALTH PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 HUSTONVILLE RD STE 9
DANVILLE KY
40422-2165
US

IV. Provider business mailing address

975 HUSTONVILLE RD STE 9
DANVILLE KY
40422-2165
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-9598
  • Fax: 859-239-9594
Mailing address:
  • Phone: 859-239-9598
  • Fax: 859-239-9594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH COX
Title or Position: PRESIDENT
Credential:
Phone: 859-239-9598