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General NPI Number Information
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NPI Number | 1629342985
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Entity Type | Organization
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Legal Business Name | THACKER FAMILY MEDICAL LLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 140 ADAMS LN SUITE 600-700
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City | PIKEVILLE
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State | KY
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Zip | 41501-3087
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Country | US
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Telephone | 606-509-2000
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Fax | 606-509-2002
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Provider Business Mailing Address
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Address Line | PO BOX 1228 140 ADAMS LANE, SUITE 600-700
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City | PIKEVILLE
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State | KY
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Zip | 41502-1228
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Country | US
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Telephone | 606-509-2000
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Fax | 606-509-2002
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Authorized Official
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Title or Position | SOILE MEMBER/OWNER
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Name | DR. CHADWARD L. THACKER
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Credential | M.D.
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Telephone | 606-509-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38711
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License Number State | KY
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