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General NPI Number Information
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NPI Number | 1528950532
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CARE ASSOCIATES 12 LLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1717 N 25TH ST STE G
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1851
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Country | US
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Telephone | 606-627-1983
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Fax | 606-645-1776
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Provider Business Mailing Address
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Address Line | PO BOX 1535
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City | BARBOURVILLE
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State | KY
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Zip | 40906-5535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GINA GOOD
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Credential | APRN
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Telephone | 606-546-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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