# CREEKSIDE FAMILY MEDICAL CENTER,PSC

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

## Provider details

- **NPI number:** 1861453524
- **Authorized official:** THOMAS CECIL CRAIN M.D. (OWNER)
- **Authorized official phone:** (502) 477-1955

## Contact information

- **Practice address:** 83 W MAIN ST, TAYLORSVILLE, KY 40071-8616
- **Practice address phone:** (502) 477-1955
- **Practice address fax:** (502) 477-5524
- **Mailing address:** PO BOX 529, TAYLORSVILLE, KY 40071-0529
- **Mailing address phone:** (502) 477-1955
- **Mailing address fax:** (502) 477-5524

## Taxonomy

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

## Other

- **Enumeration date:** 03/31/2006
- **Last updated:** 11/18/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65937534 | — | KY |