Healthcare Provider Details

I. General information

NPI: 1124084488
Provider Name (Legal Business Name): HILLTOP PRIMARY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 UPPER JOHNS CREEK RD
PHELPS KY
41553-8775
US

IV. Provider business mailing address

7617 UPPER JOHNS CREEK RD
PHELPS KY
41553-8775
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-9333
  • Fax: 606-835-9997
Mailing address:
  • Phone: 606-835-9333
  • Fax: 606-835-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900167
License Number StateKY

VIII. Authorized Official

Name: ZACH HARRIS
Title or Position: CEO
Credential:
Phone: 606-835-9333