Healthcare Provider Details

I. General information

NPI: 1356568331
Provider Name (Legal Business Name): CALDWELL COUNTY FREE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W MAIN ST
PRINCETON KY
42445-1555
US

IV. Provider business mailing address

206 W MAIN ST PO BOX 832
PRINCETON KY
42445-1555
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-0901
  • Fax: 270-365-3203
Mailing address:
  • Phone: 270-365-0901
  • Fax: 270-365-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number740125
License Number StateKY

VIII. Authorized Official

Name: MRS. DONNA MAY BOWERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-365-0901