Healthcare Provider Details

I. General information

NPI: 1043253925
Provider Name (Legal Business Name): BULLITT COUNTY FAMILY CARE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 HIGHWAY 44 EAST SUITE 2
SHEPHERDSVILLE KY
40165
US

IV. Provider business mailing address

P.O. BOX 1069
SHEPHERDSVILLE KY
40165
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-5200
  • Fax: 502-543-5244
Mailing address:
  • Phone: 502-955-5200
  • Fax: 502-543-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number32033
License Number StateKY

VIII. Authorized Official

Name: CHARLOTTE KAY INGWERSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 502-955-5200