Organization
FAMILY CARE CENTER MAGNOLIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF D KINGERY (DIRECTOR)
(270) 706-1900
Entity
Organization
Contact information
Practice address
432 MILL RD, MAGNOLIA, KY 42757-7862
(270) 324-3241
(270) 324-3244
Mailing address
PO BOX 2309, ELIZABETHTOWN, KY 42702-2309
(270) 706-1131
(270) 706-1167
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65935678
—
KY
01
—
DA0342
MEDICARE RAILROAD
KY
Enumeration date
05/12/2006
Last updated
07/29/2010
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