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NPI Code Detail

MEDICARE: MOUNT OLIVET PRIMARY CARE

MEDICARE: MOUNT OLIVET PRIMARY CARE
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
1207Q00000XFamily Medicine Physician13461KY

General Provider Information

NPI Number : 1972056661
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNT OLIVET PRIMARY CARE
Provider Business Mailing Address
First Line : 420 NORTH MAIN STREET
Second Line :
City : MOUNT OLIVET
State : KY
Zip : 41064
Country : US
Telephone Number : 606-584-8666
Fax Number : 859-234-9400
Provider Business Practice Location Address
First Line : 430 E PLEASANT ST
Second Line :
City : CYNTHIANA
State : KY
Zip : 41031-1816
Country : US
Telephone Number : 859-234-3282
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : A C WRIGHT
Credential : MD
Telephone Number : 859-234-3282
Provider Enumeration Date : 07/28/2016
Last Update Date : 07/28/2016

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Directions to “MOUNT OLIVET PRIMARY CARE ” Practice Location

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