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General NPI Number Information
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NPI Number | 1720215767
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Entity Type | Organization
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Legal Business Name | ENCLAVE FAMILY HEALTHCARE, PLC
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 3500 VILLA PT SUITE 110
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City | OWENSBORO
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State | KY
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Zip | 42303-7825
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Country | US
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Telephone | 270-685-3722
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Fax | 270-777-9283
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Provider Business Mailing Address
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Address Line | 3500 VILLA PT SUITE 110
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City | OWENSBORO
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State | KY
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Zip | 42303-7825
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Country | US
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Telephone | 270-685-3722
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Fax | 270-777-9283
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MICHAEL W JONES
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Credential | D.O., M.B.A.
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Telephone | 370-314-4394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | KY
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Taxonomy #2
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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 | KY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 017076
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License Number State | KY
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