Provider Demographics
NPI:1982845889
Name:WESTERN KY FAMILY HEALTH CARE INC
Entity type:Organization
Organization Name:WESTERN KY FAMILY HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CARRICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-251-3223
Mailing Address - Street 1:318 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2337
Mailing Address - Country:US
Mailing Address - Phone:270-251-3223
Mailing Address - Fax:270-251-3220
Practice Address - Street 1:318 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2337
Practice Address - Country:US
Practice Address - Phone:270-251-3223
Practice Address - Fax:270-251-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100090880OtherMEDICAID GRP -ARNP
KY7100083510OtherMEDICAID GRP -PHY
KY18D1098184OtherCLIA WAVE
KY18D1098184OtherCLIA WAVE