Healthcare Provider Details

I. General information

NPI: 1164413597
Provider Name (Legal Business Name): PHILLIPS PRATT MCFARLAND PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CREEK DR STE 102
MONTICELLO KY
42633-9472
US

IV. Provider business mailing address

1 S CREEK DR STE 102
MONTICELLO KY
42633-9472
US

V. Phone/Fax

Practice location:
  • Phone: 606-348-3365
  • Fax: 606-348-8496
Mailing address:
  • Phone: 606-348-3365
  • Fax: 606-348-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number200246
License Number StateKY

VIII. Authorized Official

Name: ROBERT A PARMELEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-348-3365