# FAMILY MEDICAL CARE OF MANCHESTER

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

## Provider details

- **NPI number:** 1700827599
- **Authorized official:** DR. DOUGLAS GERARDY IRWIN M.D. (OWNER)
- **Authorized official phone:** (606) 599-9955

## Contact information

- **Practice address:** 94 MARIE LANGDON DR, SUITE 1, MANCHESTER, KY 40962-6353
- **Practice address phone:** (606) 599-9955
- **Practice address fax:** (606) 599-9966
- **Mailing address:** 94 MARIE LANGDON DR, SUITE 1, MANCHESTER, KY 40962-6353
- **Mailing address phone:** (606) 599-9955
- **Mailing address fax:** (606) 599-9966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 38637 | KY | Yes |

## Other

- **Enumeration date:** 06/10/2006
- **Last updated:** 07/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000195439 | BLUE CROSS/BLUE SHIELD | KY |
| 01 | — | 020252900 | BLACK LUNG GROUP \# | KY |
| 01 | — | 1168920 | PASSPORT GROUP PROVIDER \# | KY |
| 05 | — | 31000813 | — | KY |
| 01 | — | C92418 | CUMBERLAND HEALTHCARE | KY |