# BLUEGRASS FAMILY WALK-IN CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124596341
- **Authorized official:** DR. CHADWARD LEE THACKER MD (OWNER)
- **Authorized official phone:** (606) 509-2000

## Contact information

- **Practice address:** 140 ADAMS LN STE 600-700, PIKEVILLE, KY 41501-3087
- **Practice address phone:** (606) 509-2000
- **Mailing address:** PO BOX 1228, PIKEVILLE, KY 41502-1228
- **Mailing address phone:** (606) 509-2000
- **Mailing address fax:** (606) 509-2002

## Taxonomy

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

## Other

- **Enumeration date:** 11/06/2018
- **Last updated:** 11/06/2018