Organization
MCCREARY PRIMARY CARE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH E ALLISON (PRESIDENT)
(859) 578-4822
Entity
Organization
Contact information
Practice address
65 CENTER AVE, WHITLEY CITY, KY 42653-0000
(606) 376-2224
(606) 376-2205
Mailing address
PO BOX 129, WHITLEY CITY, KY 42653-0000
(606) 376-2224
(606) 376-2205
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02506
KY
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000597415
ANTHEM
KY
05
—
7100029190
—
KY
05
—
7100300430
—
KY
Enumeration date
12/11/2007
Last updated
11/24/2014
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