Organization
EAST BERNSTADT MEDICAL CLINIC PLLC
Active
Other names
Annville 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
78 HIGHWAY 3444, ANNVILLE, KY 40402-8245
(606) 364-5162
(606) 364-3920
Mailing address
2659 NORTH LAUREL ROAD, P O BOX 495, EAST BERNSTADT, KY 40729-0000
(606) 843-6195
(606) 843-6222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100071750
—
KY
Enumeration date
03/23/2006
Last updated
10/29/2025
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