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NPI Code Detail

MEDICARE: ELKTON CLINIC PSC

MEDICARE: ELKTON CLINIC 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
1363L00000XNurse Practitioner
2363A00000XPhysician Assistant
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1457667461
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELKTON CLINIC PSC
Provider Business Mailing Address
First Line : PO BOX 487
Second Line :
City : ELKTON
State : KY
Zip : 42220-0487
Country : US
Telephone Number : 270-265-5353
Fax Number :
Provider Business Practice Location Address
First Line : 713 W MAIN ST
Second Line :
City : ELKTON
State : KY
Zip : 42220-9229
Country : US
Telephone Number : 270-265-5353
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MANOJ H MAJMUDAR
Credential : MD
Telephone Number : 270-886-8840
Provider Enumeration Date : 08/27/2010
Last Update Date : 03/24/2011

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Directions to “ELKTON CLINIC PSC ” Practice Location

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