Healthcare Provider Details

I. General information

NPI: 1053300681
Provider Name (Legal Business Name): FAMILY PHYSICIAN ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 HOSPITAL DR SUITE 1
SHELBYVILLE KY
40065-1619
US

IV. Provider business mailing address

515 HOSPITAL DR SUITE 1
SHELBYVILLE KY
40065-1619
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-3525
  • Fax: 502-633-3825
Mailing address:
  • Phone: 502-633-3525
  • Fax: 502-633-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES R SMITH
Title or Position: MD
Credential: MD
Phone: 502-633-3525