Healthcare Provider Details

I. General information

NPI: 1114187622
Provider Name (Legal Business Name): PRIMARY CARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

1000 S 12TH ST
MURRAY KY
42071-9303
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9200
  • Fax: 270-759-9966
Mailing address:
  • Phone: 270-759-9200
  • Fax: 270-759-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: ROBERT C HUGHES
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 270-759-9200