Organization
EAST BERNSTADT MEDICAL CLINIC PLLC
Active
Organization
EAST BERNSTADT MEDICAL CLINIC PLLC
Active
Other names
East Bernstadt Medical Clinic PLLC, East Bernstadt Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA JEAN JOHNSON (BILLING/CREDENTIALING CLERK)
(606) 843-6195
Entity
Organization
Contact information
Practice address
2659 N LAUREL RD, LONDON, KY 40741-9075
(606) 843-6195
(606) 843-6222
Mailing address
2659 N LAUREL RD, LONDON, KY 40741-9075
(606) 843-6195
(606) 843-6222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65907750
—
KY
05
—
7100045270
—
KY
05
—
7100048870
—
KY
05
—
7100163280
—
KY
05
—
7100163300
—
KY
05
—
7100163320
—
KY
Enumeration date
03/23/2006
Last updated
10/29/2025
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