Faith Family Practice PLLC
Organization Active NPI Primary Care Clinic/Center · West Liberty, KY
NPI 1154547347 · NPPES record last updated Aug 5, 2008
Key facts
- NPI
- 1154547347
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- FAITH FAMILY PRACTICE PLLC
- Practice address
- 801 N. Main STR.
West Liberty, KY 41472-1021 - Phone
- (606) 743-1422
- Fax
- (606) 743-3044
- NPI assigned
- Apr 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Angela M. Davis
- Title
- Office Manager
- Phone
- (606) 743-1422
Practitioners 2
-
L Brent Davis, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0977947 | Faith Family Practice | Provider-performed microscopy | Sep 10, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050927001185 | KY | Part B Supplier - Clinic/Group Practice | 1658306816 |
Receives reassigned benefits from 2 practitioners Practice locations: West Liberty, KY |
National Provider Directory
Locations
801 Main St
West Liberty, KY 41472
Phone (606) 743-1422
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
801 N. Main STR.
West Liberty, KY 41472-1021
Mailing address
801 Main St
West Liberty, KY 41472-1021
Phone (606) 743-1422
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65905721 | Medicaid | KY |
Other providers in West Liberty, KY
- James Lawrence Duff
- Bianca Dulin
- East Valley Elementary
- Tracy Jewell Elam
- Phyllis Ann Eldridge
- Crystal Marie Fletcher-Jones
- Frederick & Smith Inc
- Frederick Medical Clinic PSC
- James Denzil Frederick
- Melissa Lynn Frederick
All providers in West Liberty, KY · Primary Care Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.