# CLARK REGIONAL PHYSICIAN PRACTICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clark Regional Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114360583
- **Authorized official:** SARA MILLER (DIRECTOR)
- **Authorized official phone:** (615) 202-9581

## Contact information

- **Practice address:** 120 PROFESSIONAL AVE, WINCHESTER, KY 40391-1116
- **Practice address phone:** (859) 744-2485
- **Practice address fax:** (859) 744-0062
- **Mailing address:** 330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
- **Mailing address phone:** (615) 920-7905
- **Mailing address fax:** (615) 920-8935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2013
- **Last updated:** 09/27/2017