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NPI Code Detail

MEDICARE: FAMILY CARE PHYSICIANS PSC

MEDICARE: FAMILY CARE PHYSICIANS PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3DD1879OTHERKYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11063576601OTHERKYNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063576601
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY CARE PHYSICIANS PSC
Provider Business Mailing Address
First Line : 2701 CHAMBERLAIN LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40245-1603
Country : US
Telephone Number : 502-243-8481
Fax Number :
Provider Business Practice Location Address
First Line : 2701 CHAMBERLAIN LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40245-1603
Country : US
Telephone Number : 502-243-8481
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : TONYA D JESSE
Credential :
Telephone Number : 502-243-8481
Provider Enumeration Date : 12/20/2006
Last Update Date : 12/19/2019

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Directions to “FAMILY CARE PHYSICIANS PSC ” Practice Location

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