MEDICARE: ROSS FAMILY MEDICAL

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	261QP2300X	Primary Care Clinic/Center
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1184326977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS FAMILY MEDICAL

Provider Business Mailing Address
First Line	:	PO BOX 1111
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653-1111
Country	:	US
Telephone Number	:	606-376-7077
Fax Number	:	606-376-7076

Provider Business Practice Location Address
First Line	:	69 S MAIN ST
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653-6043
Country	:	US
Telephone Number	:	606-376-7077
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY R ROSS
Credential	:
Telephone Number	:	606-376-7077

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	09/03/2024

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