MEDICARE: STRAUSS FAMILY PRACTICE, LLC

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	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ2363	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831131481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRAUSS FAMILY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	225 RICHMOND STREET
Second Line	:	P.O. BOX 4019
City	:	MT. VERNON
State	:	KY
Zip	:	40456-4019
Country	:	US
Telephone Number	:	606-392-2301
Fax Number	:	606-392-2304

Provider Business Practice Location Address
First Line	:	402 RICHMOND RD N
Second Line	:	SUITE B
City	:	BEREA
State	:	KY
Zip	:	40403-1133
Country	:	US
Telephone Number	:	859-986-9521
Fax Number	:	859-986-7369

Authorized Official
Title or Position	:	OWNER
Name	:	JON M STRAUSS
Credential	:	MD
Telephone Number	:	606-392-2301

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/08/2011

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Directions to “STRAUSS FAMILY PRACTICE, LLC ” Practice Location

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