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General NPI Number Information
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NPI Number | 1497938583
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Entity Type | Organization
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Legal Business Name | MCCREARY PRIMARY CARE CENTER, INC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 65 CENTER AVE
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City | WHITLEY CITY
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State | KY
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Zip | 42653-0000
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Country | US
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Telephone | 606-376-2224
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Fax | 606-376-2205
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | WHITLEY CITY
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State | KY
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Zip | 42653-0000
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Country | US
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Telephone | 606-376-2224
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Fax | 606-376-2205
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KENNETH E ALLISON
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Credential |
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Telephone | 859-578-4822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 02506
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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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