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General NPI Number Information
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NPI Number | 1639654809
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Entity Type | Organization
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Legal Business Name | BARDSTOWN PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 102 W DEPOT ST
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City | SPRINGFIELD
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State | KY
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Zip | 40069-1159
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Country | US
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Telephone | 502-348-6309
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S 5TH ST
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City | BARDSTOWN
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State | KY
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Zip | 40004-1142
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Country | US
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Telephone | 502-348-6309
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARY JO NALLEY
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Credential |
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Telephone | 502-348-7554
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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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