MEDICARE: CARLISLE 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
1	261QR1300X	Rural Health Clinic/Center	900162	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	:	1588690259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLISLE CLINIC, PSC

Provider Business Mailing Address
First Line	:	107 S BROADWAY ST
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-1150
Country	:	US
Telephone Number	:	859-289-4124
Fax Number	:	859-289-4126

Provider Business Practice Location Address
First Line	:	107 S BROADWAY ST
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-1150
Country	:	US
Telephone Number	:	859-289-4124
Fax Number	:	859-289-4126

Authorized Official
Title or Position	:	OWNER
Name	:	JANET TAMAREN
Credential	:	M.D.
Telephone Number	:	859-289-4124

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	03/11/2008

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