Organization
CREEKSIDE FAMILY MEDICAL CENTER,PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS CECIL CRAIN M.D. (OWNER)
(502) 477-1955
Entity
Organization
Contact information
Practice address
83 W MAIN ST, TAYLORSVILLE, KY 40071-8616
(502) 477-1955
(502) 477-5524
Mailing address
PO BOX 529, TAYLORSVILLE, KY 40071-0529
(502) 477-1955
(502) 477-5524
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65937534
—
KY
Enumeration date
03/31/2006
Last updated
11/18/2009
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