Organization
CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRITT LEWIS JR. (ADMINISTRATOR)
(606) 837-2108
Entity
Organization
Contact information
Practice address
209 E MOUND ST, HARLAN, KY 40831-2321
(606) 573-1975
(606) 837-9389
Mailing address
101 CHAD ST, BOX 39, EVARTS, KY 40828-8200
(606) 837-2108
(606) 837-9389
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
KY
261QR1300X
Rural Health Clinic/Center
900168
KY
Other
Enumeration date
06/27/2013
Last updated
11/20/2018
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