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General NPI Number Information
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NPI Number | 1861453524
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Entity Type | Organization
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Legal Business Name | CREEKSIDE FAMILY MEDICAL CENTER,PSC
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 83 W MAIN ST
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City | TAYLORSVILLE
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State | KY
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Zip | 40071-8616
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Country | US
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Telephone | 502-477-1955
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Fax | 502-477-5524
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Provider Business Mailing Address
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Address Line | PO BOX 529
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City | TAYLORSVILLE
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State | KY
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Zip | 40071-0529
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Country | US
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Telephone | 502-477-1955
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Fax | 502-477-5524
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS CECIL CRAIN
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Credential | M.D.
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Telephone | 502-477-1955
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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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