ADVANCED FAMILY MEDICAL CLINIC LIBERTY (NPI# 1023545241) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023545241 |
| Entity Type | Organization |
| Organization Name | ADVANCED FAMILY MEDICAL CLINIC LIBERTY |
| Practice Address |
84 Hustonville St Liberty KY 42539-3456 |
| Mailing Address |
84 Hustonville St Liberty KY 42539-3469 |
| Practice Telephone | 8596910201 |
| Mailing Telephone | 6063039011 |
| Mailing Fax Number | 6063039170 |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2020-02-27 |
| Authorized Official Name | DR. KHURSHEED AKRAM SIDDIQUI (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6063039011 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 28741 | KY | Allopathic & Osteopathic Physicians |
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100503210 | 05 | |
| KY | 65942906 | 05 |
| Street Address |
84 HUSTONVILLE ST |
| City | LIBERTY |
| State | KY |
| Zip Code | 42539-3456 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598196123 | Kristi Robin Bohanon | Counselor | 84 Hustonville St, Liberty, KY 42539-3469 | 2013-12-08 |
| 1679093876 | Robin Leann Atwood | Nurse Practitioner | 84 Hustonville St, Liberty, KY 42539-3456 | 2017-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710547211 | Adult Day Health, Inc. | Clinic/Center | 39 Hwy 49, Liberty, KY 42539 | 2019-06-17 |
| 1144521303 | David Antonio Medina | Chiropractor | 69 Hustonville St., Liberty, KY 42539 | 2010-11-04 |
| 1356677694 | Masata, Inc. | Community/Behavioral Health | 549 Middleburg St., Liberty, KY 42539 | 2009-10-21 |
| 1174798078 | Dr. Michele Beeler, D.m.d., Pllc | Dentist | 650 Whipp Avenue, Liberty, KY 42539 | 2008-04-23 |
| 1134314230 | Cundiff Family Chiropractic, Psc | Chiropractor | 256 N. Wallace Wilkinson Blvd., Liberty, KY 42539 | 2007-09-11 |
| 1770782633 | Lake Cumberland District Health | Public Health or Welfare | 2834 S. Us 127, Liberty, KY 42539 | 2007-07-12 |
| 1568596286 | Back and Body Chiropractic Center Inc. | Chiropractor | 69 Hustonville Street, Liberty, KY 42539 | 2007-03-15 |
| 1497890545 | Lake Cumberland District Health Department | Public Health or Welfare | 199 Adams Street, Liberty, KY 42539 | 2007-02-20 |
| 1891836581 | Stanford Family Medicine & Obstetrics Psc | Legal Medicine | 19 Abes Plaza, Old Hustonville Rd, Liberty, KY 42539 | 2007-02-08 |
| 1740331537 | Sheila Ann Ping | Speech-Language Pathologist | 7235 Thomas Ridge Road, Liberty, KY 42539 | 2007-01-16 |
| Find all providers in zip 42539 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679926992 | Liberty County Hospital District No 1 | Clinic/Center | 1353 N Travis St, Liberty, TX 77575-3549 | 2016-07-21 |
| 1902224876 | Cannon Memorial Hospital | Clinic/Center | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2014-03-28 |
| 1962759837 | Reid Physician Associates, Inc | Clinic/Center | 950 N Market St, Liberty, IN 47353-8496 | 2012-08-10 |
| 1679720114 | Casey County Hospital District | Clinic/Center | 112 Liberty Sq, Liberty, KY 42539-3392 | 2008-08-27 |
| 1164598090 | Waldo County General Hospital | Clinic/Center | 43 West Main Street, Liberty, ME 04949 | 2006-11-24 |
| 1871567362 | Casey County Hospital District | Clinic/Center | 187 Wolford Ave, Liberty, KY 42539-3187 | 2006-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669072757 | Arh Mary Breckinridge Health Services, Inc. | Clinic/Center | 302 Walnut Street, Pineville, KY 40977 | 2020-10-28 |
| 1316553167 | Flaget Healthcare Inc | Clinic/Center | 2387 Main St, Willisburg, KY 40078-8102 | 2020-09-17 |
| 1710590880 | Flaget Healthcare, Inc | Clinic/Center | 4359 Shepherdsville Road, Ste 255, Bardstown, KY 40004 | 2020-08-28 |
| 1649881335 | Emerald Therapy Center, LLC | Clinic/Center | 111 Poplar St, Murray, KY 42071-2571 | 2020-08-14 |
| 1407472319 | Family Health Care Associates 7 Limited Liability Company | Clinic/Center | 422 N Highway 27, Whitley City, KY 42653 | 2020-06-17 |
| 1154950699 | Family Health Care Associates 6 Limited Liability Company | Clinic/Center | 8070 Us Highway 60 W, Lewisport, KY 42351-7087 | 2020-04-06 |
| 1568098838 | Appalachian Regional Healthcare, Inc | Clinic/Center | 186 Breanna Blvd, Suite 100, Salyersville, KY 41465-7525 | 2020-03-19 |
| 1780217794 | Family Health Care Associates 5 Limited Liability Company | Clinic/Center | 74 H&b Partin Lane, Pineville, KY 40977 | 2020-02-18 |
| 1023649514 | Memorial Hospital Inc | Clinic/Center | 485 Memorial Dr Ste 1, Manchester, KY 40962-9111 | 2020-02-03 |
| 1265072946 | Baptist Health Medical Group Inc | Clinic/Center | 800 Hospital Dr Fl 2, Madisonville, KY 42431-1658 | 2020-01-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.