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Organization
CLARK FAMILY CARE
Active
Organization
CLARK FAMILY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT MOORE MD (OWNER)
(859) 745-4469
Entity
Organization
Contact information
Practice address
29 CANARY LN, WINCHESTER, KY 40391-1645
(859) 745-4469
(859) 745-6918
Mailing address
29 CANARY LN, WINCHESTER, KY 40391-1645
(859) 745-4469
(859) 745-6918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38679
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000326872
BCBS PROVIDER ID
KY
01
—
1213053
CHA PROVIDER ID
KY
05
—
35001700
—
KY
05
—
64075468
—
KY
Enumeration date
08/09/2006
Last updated
12/02/2011
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