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
101 CHAD ST, CLOVER FORK CLINIC, EVARTS, KY 40828-8200
(606) 837-2108
(606) 837-9389
Mailing address
101 CHAD ST, PO BOX39, 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
261QP2300X
Primary Care Clinic/Center
700006
KY
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31000045
—
KY
05
—
7100323670
—
KY
Enumeration date
06/11/2006
Last updated
11/19/2018
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