# ESTILL MEDICAL CLINIC, PSC

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

## Provider details

- **NPI number:** 1154500296
- **Authorized official:** DONNA R ISFORT APRN (OWNER)
- **Authorized official phone:** (606) 723-2167

## Contact information

- **Practice address:** 275 COURT ST, IRVINE, KY 40336-1077
- **Practice address phone:** (606) 723-2167
- **Practice address fax:** (606) 723-2112
- **Mailing address:** 275 COURT ST, IRVINE, KY 40336-1077
- **Mailing address phone:** (606) 723-2167
- **Mailing address fax:** (606) 723-2112

## Taxonomy

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

## Other

- **Enumeration date:** 10/25/2007
- **Last updated:** 11/09/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000507512 | ANTHEM | KY |
| 05 | — | 64142649 | — | KY |