# KENTUCKY MSO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Georgetown Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710252622
- **Authorized official:** TIMOTHY D VAUGHN (VICE PRESIDENT)
- **Authorized official phone:** (615) 372-8500

## Contact information

- **Practice address:** 1138 LEXINGTON RD, SUITE 130, GEORGETOWN, KY 40324-9672
- **Practice address phone:** (502) 867-0420
- **Practice address fax:** (502) 867-0222
- **Mailing address:** 1138 LEXINGTON RD, SUITE 130, GEORGETOWN, KY 40324-9672
- **Mailing address phone:** (502) 867-0420
- **Mailing address fax:** (502) 867-0222

## Taxonomy

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

## Other

- **Enumeration date:** 03/12/2012
- **Last updated:** 03/12/2012