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General NPI Number Information
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NPI Number | 1851959217
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Entity Type | Organization
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Legal Business Name | SOUTH MAIN CLINIC LLC
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 1913 S MAIN ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-3353
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Country | US
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Telephone | 270-404-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 S MAIN ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-3353
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Country | US
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Telephone | 270-404-3411
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT/MEMBER
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Name | DR. JAMES BRADLEY ASHBY
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Credential | PHARMD
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Telephone | 270-404-3411
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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