Provider Demographics
NPI:1730213406
Name:FAMILY MEDICINE ASSOCIATES OF WESTERN KENTUCKY, PLLC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF WESTERN KENTUCKY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-898-2444
Mailing Address - Street 1:6035 KENTUCKY DAM RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9472
Mailing Address - Country:US
Mailing Address - Phone:270-898-2444
Mailing Address - Fax:270-898-4753
Practice Address - Street 1:6035 KENTUCKY DAM RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9472
Practice Address - Country:US
Practice Address - Phone:270-898-2444
Practice Address - Fax:270-898-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65937138Medicaid