Basic Information
| Provider Information | |||||||||
| NPI: | 1972056661 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT OLIVET PRIMARY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 NORTH MAIN STREET | ||||||||
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| City: | MOUNT OLIVET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065848666 | ||||||||
| FaxNumber: | 8592349400 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 E PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | CYNTHIANA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410311816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592343282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2016 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | A C | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592343282 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A. C. WRIGHT PSC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 13461 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.