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General NPI Number Information
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NPI Number | 1417624586
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 306 HOSPITAL DR STE 101
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City | SOUTH WILLIAMSON
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State | KY
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Zip | 41503-4023
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Country | US
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Telephone | 606-237-1000
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Fax | 606-237-1001
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Provider Business Mailing Address
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Address Line | 68 PAULEY HOLW
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City | FOREST HILLS
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State | KY
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Zip | 41527-8349
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Country | US
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Telephone | 606-371-0378
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MANSOOR MAHMOOD
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Credential | MD
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Telephone | 606-371-0378
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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 | 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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