Organization Name: | FAITH FAMILY PRACTICE PLLC |
NPI Number: | 1154547347 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANGELA M. DAVIS (OFFICE MANAGER) |
Mailing Address: | 801 N. Main Str. West Liberty |
State: | KY US |
Postal Code: | 414721021 |
Phone Number: | 6067431422 |
Fax Number: | 6067433044 |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 08/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |