Provider Demographics
NPI:1366227555
Name:PRIMARY CARE CENTERS OF EASTERN KENTUCKY, LLC
Entity type:Organization
Organization Name:PRIMARY CARE CENTERS OF EASTERN KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RAEDAWNUA
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:STRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-435-7642
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1988
Mailing Address - Country:US
Mailing Address - Phone:606-435-7642
Mailing Address - Fax:606-436-5282
Practice Address - Street 1:47 HIGHWAY 119 S
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-6100
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:606-439-1400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE CENTERS OF EASTERN KENTUCKY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center