Healthcare Provider Details

I. General information

NPI: 1841397056
Provider Name (Legal Business Name): FIRST YOU MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E BROADWAY ST
EMINENCE KY
40019-1149
US

IV. Provider business mailing address

PO BOX 124
EMINENCE KY
40019-0124
US

V. Phone/Fax

Practice location:
  • Phone: 502-845-6288
  • Fax: 888-310-2675
Mailing address:
  • Phone: 502-593-0083
  • Fax: 888-310-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900262
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNA STIVERS DAVE
Title or Position: MEMBER/OWNER
Credential: RN
Phone: 502-593-0083