Organization
CALDWELL COUNTY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA EVANS (PROVIDER ENROLLMENT REP)
(270) 744-9600
Entity
Organization
Contact information
Practice address
323 S JEFFERSON ST, SUITE D, PRINCETON, KY 42445-2100
(270) 365-4505
(270) 365-4539
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-8642
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65942872
—
KY
Enumeration date
08/30/2006
Last updated
03/17/2009
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