Healthcare Provider Details

I. General information

NPI: 1811987696
Provider Name (Legal Business Name): NICHOLS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ELKHORN ST
ELKHORN CITY KY
41522
US

IV. Provider business mailing address

1002 S BROADWAY ST STE 7
GEORGETOWN KY
40324-1463
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-5076
  • Fax: 606-754-5557
Mailing address:
  • Phone: 606-754-5076
  • Fax: 606-754-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER SAAD
Title or Position: PRESIDENT
Credential:
Phone: 318-259-7334