MEDICARE: CORBIN FAMILY PRACTICE CLINIC, INC.

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
1	363L00000X	Nurse Practitioner	2774P	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1134122468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORBIN FAMILY PRACTICE CLINIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1125
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40702-1125
Country	:	US
Telephone Number	:	606-528-0283
Fax Number	:	606-528-8422

Provider Business Practice Location Address
First Line	:	1400 CUMBERLAND FALLS HWY
Second Line	:	STE C
City	:	CORBIN
State	:	KY
Zip	:	40701-2739
Country	:	US
Telephone Number	:	606-258-8787
Fax Number	:	606-258-8788

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT A. CARTER JR.
Credential	:
Telephone Number	:	606-528-0283

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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