Organization
BLUEGRASS FAMILY WALK-IN CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHADWARD LEE THACKER MD (OWNER)
(606) 509-2000
Entity
Organization
Contact information
Practice address
140 ADAMS LN STE 600-700, PIKEVILLE, KY 41501-3087
(606) 509-2000
Mailing address
PO BOX 1228, PIKEVILLE, KY 41502-1228
(606) 509-2000
(606) 509-2002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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