Main Street Family Medicine, LLC
Organization Active NPI Family Nurse Practitioner · Whitesville, KY
NPI 1528097433 · NPPES record last updated Mar 21, 2022
Key facts
- NPI
- 1528097433
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2848P (KY)
- Legal business name
- MAIN STREET FAMILY MEDICINE, LLC
- Practice address
- 10015 Main St
Whitesville, KY 42378-9557 - Phone
- (270) 233-1884
- Fax
- (270) 233-9520
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Cynthia Dianne Glenn-Birkhead, ARNP
- Title
- Owner
- Phone
- (270) 233-1884
Practitioners 6
-
Kristin P. Boothe, APRN
-
Tamara Kay Rhodes, NP,AGACNP
-
Judy G Bandy, FNP
-
Julie Anne Salisbury, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D1055208 | Main Street Family Medicine | Certificate of waiver | Jun 11, 2028 |
| 18D2121162 | Main Street Family Medicine | Certificate of waiver | Oct 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060925000325 | KY | Part B Supplier - Clinic/Group Practice | 2466457593 |
Receives reassigned benefits from 6 practitioners Practice locations: Whitesville, KY |
National Provider Directory
Locations
273 Main St
Calhoun, KY 42327
Phone (270) 273-3773
2429 W Parrish Ave
Ste 3
Owensboro, KY 42301
2429 W Parrish Ave
Owensboro, KY 42301
Phone (270) 344-0234
2429 W Parrish Ave
#3
Owensboro, KY 42301
Phone (270) 215-0325
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X | 2848P | KY | Yes |
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
10015 Main St
Whitesville, KY 42378-9557
Mailing address
10015 Main St
Whitesville, KY 42378-9557
Phone (270) 233-1884
Other practice location 1
2429 W Parrish Ave # 3
Owensboro, KY 42301-2661
Phone (270) 215-0325
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PASSPORT | Other | KY | 50010742 |
| BLUE CROSS BLUE SHIE | Other | KY | 000000480521 |
Other providers in Whitesville, KY
- Duvall Child Development Center, LLC
- Cynthia Diane Glenn-Birkhead
- Emma Grant
- Jamie Michelle Hamilton
- Kentucky Orthopedic Rehabilitation, LLC
- Stephanie Ann Millay
- Non Emergency Medical Transportation of Kentucky
- Deborah G Rhodes
- Tamara Kay Rhodes
- Zechariah James Roberts
All providers in Whitesville, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2022. 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.