Egan Clinic PSC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

39726 Issued in KY

Legal business name

EGAN CLINIC PSC

Practice address

12945 W Highway 42
Prospect, KY 40059-9107

Phone

(502) 228-7530

Fax

(502) 228-7533

NPI assigned

Mar 2, 2012

Last updated

Jul 24, 2013By 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

Lynn O Egan, MD

Title

President

Phone

(502) 228-7530

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1700150109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12945 W HIGHWAY 42",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599107",
            "telephone_number": "502-228-7530",
            "fax_number": "502-228-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12945 W HIGHWAY 42",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599107",
            "telephone_number": "502-228-7530",
            "fax_number": "502-228-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EGAN CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-02",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-228-7530",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "39726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100195370",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Prospect, KY
• Providers in Prospect, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.