Georgetown Medical, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

810355 Issued in KY

Legal business name

GEORGETOWN MEDICAL, LLC

Practice address

105 Eastside Dr
Georgetown, KY 40324-9797

Phone

(502) 868-0664

NPI assigned

May 21, 2014

Last updated

Sep 10, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robyn Tanis

Title

Executive Director of Contract MGMT

Phone

(856) 533-8762

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Opioid treatment program

Medicare-enrolled since Jul 6, 2022

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1063824381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73 STE 200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-439-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 EASTSIDE DR",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249797",
            "telephone_number": "502-868-0664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Eastside Dr",
            "address_2": "Suites A, B, and C",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "KY",
            "postal_code": "403249797",
            "country_code": "US",
            "telephone_number": "502-868-0664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GEORGETOWN MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-21",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "TANIS",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF CONTRACT MGMT",
        "authorized_official_telephone_number": "856-533-8762"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "KY",
            "license": "810355",
            "primary": true
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "810355",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgetown Family Dentistry, LLC
• Georgetown Family Physicians, PSC
• Georgetown Integrated Medicine PSC
• Georgetown Internal Medicine
• Georgetown Ky Pharmacy LLC (Georgetown Pharmacy)
• Georgetown Obstetrics and Gynecology P.S.C.
• Georgetown Obstetrics and Gynecology PSC
• Georgetown Open MRI Center
• Georgetown Oral and Facial Surgery, LLC
• Georgetown Pediatrics, PSC

• Methadone Clinic in Georgetown, KY
• Providers in Georgetown, KY by specialty
• Methadone Clinic in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.