NPIMap

Organization Active NPI

Williamsburg Family Practice Clinic

  • Family Medicine Physician
  • Williamsburg, KY
National Provider Identifier
1720030620
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
900113 Issued in KY
Legal business name
WILLIAMSBURG FAMILY PRACTICE CLINIC
Practice address
965 S Highway 25 W
Williamsburg, KY 40769-1608
Phone
(606) 549-2588
Fax
(606) 549-1945
NPI assigned
May 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert A. Carter
Title
President
Phone
(606) 528-0283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 900113 KY Primary

Addresses

Primary practice location

965 S Highway 25 W
Williamsburg, KY 40769-1608

Mailing address

PO Box 1125
Corbin, KY 40702-1125
Phone (606) 528-0283

Other identifiers 1

IdentifierTypeStateIssuer
35001098MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Williamsburg Family Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1007 18TH St Ste 2
Corbin, KY 40701

103 Main St
Manchester, KY 40962
Phone (606) 598-5025

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720030620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1125",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407021125",
            "telephone_number": "606-528-0283",
            "fax_number": "606-528-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 S HIGHWAY 25 W",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691608",
            "telephone_number": "606-549-2588",
            "fax_number": "606-549-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSBURG FAMILY PRACTICE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-528-0283"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "900113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001098",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.