NPIMap

Organization Active NPI

Family Practice Clinic PSC

  • Family Medicine Physician
  • Marion, KY
National Provider Identifier
1467454041
Registry record updated Feb 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY PRACTICE CLINIC PSC
Practice address
518 West Gum Street
Marion, KY 42064-1516
Phone
(270) 965-5238
Fax
(270) 965-9015
NPI assigned
Aug 12, 2005
Last updated
Feb 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2011

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

Authorized official

Name
Howard G Maddux, MDNPI 1578565156
Title
President
Phone
(270) 965-5238

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

518 West Gum Street
Marion, KY 42064-1516

Mailing address

PO Box 559
Marion, KY 42064-0559
Phone (270) 965-5238

Other identifiers 2

IdentifierTypeStateIssuer
65905770MedicaidKY
78900719MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Locations

518 W Gum St
Marion, KY 42064
Phone (270) 965-5238

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jan 4, 2021 Change of OwnershipThis provider was the seller Family Practice ClinicCCN 188536, KY, NPI 1962090134

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297209600000",
    "number": "1467454041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 559",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420640559",
            "telephone_number": "270-965-5238",
            "fax_number": "270-965-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 WEST GUM STREET",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641516",
            "telephone_number": "270-965-5238",
            "fax_number": "270-965-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-12",
        "last_updated": "2011-02-09",
        "status": "A",
        "authorized_official_last_name": "MADDUX",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-965-5238",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65905770",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78900719",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, KY

Sources for this page

Verify at the official NPI Registry.