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General NPI Number Information
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NPI Number | 1336109644
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Entity Type | Organization
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Legal Business Name | EAST BERNSTADT MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 78 HIGHWAY 3444
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City | ANNVILLE
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State | KY
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Zip | 40402-8245
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Country | US
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Telephone | 606-364-5162
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Fax | 606-364-3920
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Provider Business Mailing Address
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Address Line | 2659 NORTH LAUREL ROAD P O BOX 495
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City | EAST BERNSTADT
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State | KY
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Zip | 40729-0000
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Country | US
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Telephone | 606-843-6195
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Fax | 606-843-6222
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Authorized Official
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Title or Position | BILLING/CREDENTIALING CLERK
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Name | CARLA JEAN JOHNSON
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Credential |
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Telephone | 606-843-6195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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