# FAMILY CARE CENTER MAGNOLIA

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

## Provider details

- **NPI number:** 1194775734
- **Authorized official:** MR. JEFF D KINGERY (DIRECTOR)
- **Authorized official phone:** (270) 706-1900

## Contact information

- **Practice address:** 432 MILL RD, MAGNOLIA, KY 42757-7862
- **Practice address phone:** (270) 324-3241
- **Practice address fax:** (270) 324-3244
- **Mailing address:** PO BOX 2309, ELIZABETHTOWN, KY 42702-2309
- **Mailing address phone:** (270) 706-1131
- **Mailing address fax:** (270) 706-1167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/12/2006
- **Last updated:** 07/29/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65935678 | — | KY |
| 01 | — | DA0342 | MEDICARE RAILROAD | KY |