Healthcare Provider Details

I. General information

NPI: 1447795299
Provider Name (Legal Business Name): COMMUNITY FIRST HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 N BEND RD UNIT 100
HEBRON KY
41048
US

IV. Provider business mailing address

2091 N BEND RD STE 100
HEBRON KY
41048-9122
US

V. Phone/Fax

Practice location:
  • Phone: 859-817-1370
  • Fax:
Mailing address:
  • Phone: 859-817-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MARQUEL TIPTON
Title or Position: MEMBER
Credential: PA-C
Phone: 859-322-9984