Basic Information
| Provider Information | |||||||||
| NPI: | 1255607297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY FAMLIY CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | FRENCHBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403228123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067689190 | ||||||||
| FaxNumber: | 6067689180 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 FOXGLOVE DR | ||||||||
| Address2: | SUITE # D | ||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403539735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594983333 | ||||||||
| FaxNumber: | 8594983332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2012 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | KASSIS | ||||||||
| AuthorizedOfficialFirstName: | TAUFIK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8594983333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.