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NPI Code Detail

MEDICARE: FAMILY & INTERNAL MEDICINE ASSOCIATES PLLC

MEDICARE: FAMILY & INTERNAL MEDICINE ASSOCIATES PLLC
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
1207R00000XInternal Medicine Physician
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21077750OTHERKYPASSPORT
32435329002OTHERKYPASSPORT ADVANTAGE
418D0320437OTHERKYCLIA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780682609
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY & INTERNAL MEDICINE ASSOCIATES PLLC
Provider Business Mailing Address
First Line : 325 W WALNUT ST
Second Line : STE 600
City : LEBANON
State : KY
Zip : 40033-1378
Country : US
Telephone Number : 270-699-9500
Fax Number : 270-699-9550
Provider Business Practice Location Address
First Line : 325 W WALNUT ST
Second Line : STE 600
City : LEBANON
State : KY
Zip : 40033-1378
Country : US
Telephone Number : 270-699-9500
Fax Number : 270-699-9550
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : JIM OSBOURNE
Credential :
Telephone Number : 270-699-9500
Provider Enumeration Date : 07/13/2005
Last Update Date : 10/02/2019

Similar Medicare Providers

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1063120194 — VMD PRIMARY PROVIDERS CENTRAL KENTUCKY
Practice Location Address:
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Practice Fax: 270-699-9550

Directions to “FAMILY & INTERNAL MEDICINE ASSOCIATES PLLC ” Practice Location

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