Healthcare Provider Details

I. General information

NPI: 1871546119
Provider Name (Legal Business Name): FAMILY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEIGHBORHOOD PL
FAIRDALE KY
40118-9697
US

IV. Provider business mailing address

PO BOX 950244
LOUISVILLE KY
40295-0244
US

V. Phone/Fax

Practice location:
  • Phone: 502-361-2381
  • Fax: 502-363-1462
Mailing address:
  • Phone: 502-953-4700
  • Fax: 502-772-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number700013
License Number StateKY

VIII. Authorized Official

Name: MR. BART IRWIN
Title or Position: CEO (INTERIM)
Credential:
Phone: 502-774-8631