Organization
FAMILY PRACTICE CLINIC PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD G MADDUX MD (PRESIDENT)
(270) 965-5238
Entity
Organization
Contact information
Practice address
518 WEST GUM STREET, MARION, KY 42064-1516
(270) 965-5238
(270) 965-9015
Mailing address
PO BOX 559, MARION, KY 42064-0559
(270) 965-5238
(270) 965-9015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65905770
—
KY
05
—
78900719
—
KY
Enumeration date
08/12/2005
Last updated
02/09/2011
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