Healthcare Provider Details

I. General information

NPI: 1992863021
Provider Name (Legal Business Name): FAMILY MEDICAL SPECIALTY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/25/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 JACKSON HEIGHTS DRIVE FAMILY MEDICAL & SPECIALTY CLINIC, LLC
JACKSON KY
41339
US

IV. Provider business mailing address

12 JACKSON HEIGHTS DRIVE
JACKSON KY
41339
US

V. Phone/Fax

Practice location:
  • Phone: 606-693-0199
  • Fax: 606-666-9480
Mailing address:
  • Phone: 606-693-0199
  • Fax: 606-666-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUNE E ABADILLA
Title or Position: PRESIDENT
Credential: M.D
Phone: 606-693-0199