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Organization

FAMILY MEDICAL CARE OF MANCHESTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DOUGLAS GERARDY IRWIN M.D. (OWNER)
(606) 599-9955
Entity
Organization

Contact information

Practice address
94 MARIE LANGDON DR, SUITE 1, MANCHESTER, KY 40962-6353
(606) 599-9955
(606) 599-9966
Mailing address
94 MARIE LANGDON DR, SUITE 1, MANCHESTER, KY 40962-6353
(606) 599-9955
(606) 599-9966

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38637
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000195439
BLUE CROSS/BLUE SHIELD
KY
01
020252900
BLACK LUNG GROUP #
KY
01
1168920
PASSPORT GROUP PROVIDER #
KY
05
31000813
KY
01
C92418
CUMBERLAND HEALTHCARE
KY
Enumeration date
06/10/2006
Last updated
07/02/2008
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