Regional Health Care Affiliates Inc
Organization Active NPI Family Medicine Physician · Earlington, KY
NPI 1487020459 · NPPES record last updated Feb 12, 2018
Key facts
- NPI
- 1487020459
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 700211 (KY)
- Legal business name
- REGIONAL HEALTH CARE AFFILIATES INC
- Practice address
- 107 E Main St
Earlington, KY 42410-1333 - Phone
- (270) 667-7017
- Fax
- (270) 667-9065
- NPI assigned
- Aug 13, 2015
- Organization subpart
- No
Authorized official
- Name
- Mrs. Shelly Gobin
- Title
- Ceo
- Phone
- (270) 667-7017
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 7
Practitioners 28
-
Chelsey Aikins Bell, APRN
-
Tammy Barre, APRN
-
Kyndra Boone, PMHNP
-
Emma Buchanan, APRN
-
Lori Michelle Conger, RD, LD
-
Alissa Delano, DNP
-
Beth A Devine, APRN
-
Tabitha T Green, APRN
-
Katie Hagan, NP
-
Cameron D Hammack, APRN
-
Melissa Harmon, NP
-
Cheryl A Headen, LPCC
-
Sharon Hodges, APRN
-
Mandy Brown Kelley, LPCC
-
Winona F Lambdin, RN
-
Sue Lindsey, MSW CSW
-
Joseph Lowery, APRN
-
Lori R Marrero, APRN
-
Jennifer Nicole Melton, APRN
-
Maranda Wortham Miles, APRN
-
Jami T Perry, MD
-
Raymond T Quatro, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Federally qualified health center certification: CCN 181977
- Legal name
- REGIONAL HEALTH CARE AFFILIATES, INC
- Doing business as
- HEALTH FIRST COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 12, 2016
- Last certification
- Sep 12, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 29, 1982 in KY
- Enrollment address
- 107 E Main St
Earlington, KY 42410-1333
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Myra Braden |
Corporate Director |
Nov 25, 2015 | |
| Shelley Gobin |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee | Jan 1, 2018 | ||
| Vanessa Torres |
Corporate Director |
Nov 25, 2016 | |
| Sharon Steedley |
Corporate Director |
Nov 25, 2015 | |
| Anthony Dotson |
Corporate Director |
Nov 25, 2015 | |
| Monte D Davenport |
Corporate Director |
Nov 25, 2015 | |
| Allen Rudd |
Corporate Director |
Nov 25, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100824000119 | KY | Part B Supplier - Clinic/Group Practice | 3173668274 |
Receives reassigned benefits from 40 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clay, KY; Providence, KY; Princeton, KY; Owensboro, KY; Morganfield, KY; Henderson, KY; Earlington, KY; Calhoun, KY |
| O20160908002174 | KY | Part a Provider - Federally Qualified Health Center (FQHC) | 3173668274 | Practice locations: Earlington, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 700211 | KY | Yes |
Addresses
Primary practice location
107 E Main St
Earlington, KY 42410-1333
Mailing address
PO Box 37
Providence, KY 42450-0037
Phone (270) 667-7017
Other providers in Earlington, KY
- Baptist Health Madisonville Inc
- Community Care of Kentucky, Inc
- Mike'S Pharmacy, LLC
- Tammy Renee Sanders
- Kristina Anne Sifuentes
- Southside Pharmacy
All providers in Earlington, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2018. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.