Organization
SOUTH MAIN CLINIC LLC
Active
Organization
SOUTH MAIN CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BRADLEY ASHBY PHARMD (VICE-PRESIDENT/MEMBER)
(270) 404-3411
Entity
Organization
Contact information
Practice address
1913 S MAIN ST, MADISONVILLE, KY 42431-3353
(270) 404-3411
Mailing address
1913 S MAIN ST, MADISONVILLE, KY 42431-3353
(270) 404-3411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851959217
NPI
—
Enumeration date
05/31/2019
Last updated
07/01/2020
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