# CLARK FAMILY CARE

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

## Provider details

- **NPI number:** 1427068626
- **Authorized official:** SCOTT MOORE MD (OWNER)
- **Authorized official phone:** (859) 745-4469

## Contact information

- **Practice address:** 29 CANARY LN, WINCHESTER, KY 40391-1645
- **Practice address phone:** (859) 745-4469
- **Practice address fax:** (859) 745-6918
- **Mailing address:** 29 CANARY LN, WINCHESTER, KY 40391-1645
- **Mailing address phone:** (859) 745-4469
- **Mailing address fax:** (859) 745-6918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 38679 | KY | Yes |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 12/02/2011

## 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 |