Provider Demographics
NPI:1588690259
Name:CARLISLE CLINIC, PSC
Entity type:Organization
Organization Name:CARLISLE CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-289-4124
Mailing Address - Street 1:107 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-1150
Mailing Address - Country:US
Mailing Address - Phone:859-289-4124
Mailing Address - Fax:859-289-4126
Practice Address - Street 1:107 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-1150
Practice Address - Country:US
Practice Address - Phone:859-289-4124
Practice Address - Fax:859-289-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900162261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001676Medicaid
KY7492Medicare PIN
KYF96167Medicare UPIN
KY183922Medicare Oscar/Certification