MEDICARE: COMMUNITY HEALTH CENTERS OF WESTERN KENTUCKY, 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	261QF0400X	Federally Qualified Health Center (FQHC)	700060	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000060638	OTHER	KY	ANTHEM BLUE CROSS BLUE SH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306848650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CENTERS OF WESTERN KENTUCKY, INC.

Provider Business Mailing Address
First Line	:	480 HOPKINSVILLE ST
Second Line	:
City	:	GREENVILLE
State	:	KY
Zip	:	42345-1124
Country	:	US
Telephone Number	:	270-338-5777
Fax Number	:	270-338-5756

Provider Business Practice Location Address
First Line	:	480 HOPKINSVILLE ST
Second Line	:
City	:	GREENVILLE
State	:	KY
Zip	:	42345-1124
Country	:	US
Telephone Number	:	270-338-5777
Fax Number	:	270-338-5756

Authorized Official
Title or Position	:	CEO
Name	:	ROGER ARBUCKLE
Credential	:
Telephone Number	:	270-338-5777

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/14/2015

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