Organization
FIRST YOU MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNA STIVERS DAVE RN (MEMBER/OWNER)
(502) 593-0083
Entity
Organization
Contact information
Practice address
151 E BROADWAY ST, EMINENCE, KY 40019-1149
(502) 845-6288
(888) 310-2675
Mailing address
PO BOX 124, EMINENCE, KY 40019-0124
(502) 593-0083
(888) 310-2675
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
900262
KY
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000184588
ANTHEM
KY
01
—
1132401
PASSPORT
KY
01
—
2437746001
PASSPORT ADVANTAGE
KY
05
—
7100244840
—
KY
01
—
CK7832
RAILROAD MEDICARE
KY
Enumeration date
09/20/2006
Last updated
11/27/2015
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