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Organization

ESTILL MEDICAL CLINIC, PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONNA R ISFORT APRN (OWNER)
(606) 723-2167
Entity
Organization

Contact information

Practice address
275 COURT ST, IRVINE, KY 40336-1077
(606) 723-2167
(606) 723-2112
Mailing address
275 COURT ST, IRVINE, KY 40336-1077
(606) 723-2167
(606) 723-2112

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000507512
ANTHEM
KY
05
64142649
KY
Enumeration date
10/25/2007
Last updated
11/09/2011
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