# FAMILY PRACTICE CLINIC PSC

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

## Provider details

- **NPI number:** 1467454041
- **Authorized official:** HOWARD G MADDUX MD (PRESIDENT)
- **Authorized official phone:** (270) 965-5238

## Contact information

- **Practice address:** 518 WEST GUM STREET, MARION, KY 42064-1516
- **Practice address phone:** (270) 965-5238
- **Practice address fax:** (270) 965-9015
- **Mailing address:** PO BOX 559, MARION, KY 42064-0559
- **Mailing address phone:** (270) 965-5238
- **Mailing address fax:** (270) 965-9015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/12/2005
- **Last updated:** 02/09/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65905770 | — | KY |
| 05 | — | 78900719 | — | KY |