Community Health Clinic, Inc.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

COMMUNITY HEALTH CLINIC, INC.

Doing business as

Community Health Clinic of Hardin and Larue Counties
Community Health Clinic, Inc.

Practice address

1113 Woodland Dr
Elizabethtown, KY 42701-2749

Phone

(270) 763-9589

Fax

(270) 763-9689

NPI assigned

Jan 28, 2019

Last updated

May 31, 2022By 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

Jessica Dailey

Title

Executive Assistant

Phone

(270) 763-9589

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• COMMUNITY HEALTH CLINIC OF HARDIN AND LARUE COUNTIES Doing business as
• Community Health Clinic, Inc. Doing business as

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1255895850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 WOODLAND DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012749",
            "telephone_number": "270-763-9589",
            "fax_number": "270-763-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 WOODLAND DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012749",
            "telephone_number": "270-763-9589",
            "fax_number": "270-763-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-28",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "DAILEY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "270-763-9589"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100744700",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMMUNITY HEALTH CLINIC OF HARDIN AND LARUE COUNTIES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COMMUNITY HEALTH CLINIC OF HARDIN AND LARUE COUNTIES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Health Clinic, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Physician in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• General Practice Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.