=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689676850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. PHIL AARON MEDICAL CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 02/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 BURKESVILLE ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42728-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-384-1110
-----------------------------------------------------
Fax | 270-384-3436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 BURKESVILLE ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42728-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-384-1110
-----------------------------------------------------
Fax | 270-384-3436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER MEMBER
-----------------------------------------------------
Name | DR. PHIL AARON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 270-384-1110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 900046
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------