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General NPI Number Information
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NPI Number | 1497817944
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL SPECIALTY CLINIC D.B.A.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 95 JACKSON HTS
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City | JACKSON
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State | KY
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Zip | 41339-6500
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Country | US
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Telephone | 606-693-0199
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Fax | 606-693-0299
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Provider Business Mailing Address
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Address Line | 4 JACKSON HTS
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City | JACKSON
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State | KY
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Zip | 41339-6500
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Country | US
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Telephone | 606-666-7040
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Fax | 606-666-7088
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Authorized Official
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Title or Position | PARTNER
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Name | JUNE ABADILLA
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Credential | M.D.
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Telephone | 606-666-7040
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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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