Organization Name: | BIG SANDY HEALTH CARE, INC |
NPI Number: | 1104055805 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANCIL LEWIS (CEO) |
Mailing Address: | 6500 Highway 645 Ste 110 Inez |
State: | KY US |
Postal Code: | 412242044 |
Phone Number: | 6062983412 |
Fax Number: | 6062983416 |
NPI Enumeration Date: | 07/02/2009 |
NPI Last Update Date: | 12/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 700203 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |