Organization
FAMILY WELLCARE CLINIC, PLLC
Active
Organization
FAMILY WELLCARE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMAD ANTONE HADDAD MD (MANAGER)
(859) 481-7113
Entity
Organization
Contact information
Practice address
805 BARDSTOWN RD STE 12, SPRINGFIELD, KY 40069
(859) 481-7113
(859) 481-7114
Mailing address
805 BARDSTOWN RD STE 12, SPRINGFIELD, KY 40069-1515
(859) 481-7113
(859) 481-7114
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64065865
—
KY
Enumeration date
09/14/2017
Last updated
07/21/2022
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