Freeman Family Practice LLC
Organization Active NPI Rural Health Clinic/Center · Gray, KY
NPI 1750557302 · NPPES record last updated May 12, 2014
Key facts
- NPI
- 1750557302
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 900220 (KY)
- Legal business name
- FREEMAN FAMILY PRACTICE LLC
- Practice address
- 10755 N US Highway 25E
Gray, KY 40734-6529 - Phone
- (606) 258-8050
- Fax
- (606) 258-8994
- NPI assigned
- May 5, 2008
- Organization subpart
- No
Authorized official
- Name
- Tammy L Freeman, ARNP
- Title
- Owner
- Phone
- (606) 258-8050
Owners & managing parties with NPI records 1
-
Tammy L Freeman, APRN
Practitioners 6
-
Ashley Nicole Carpenter, APRN
-
Tammy L Freeman, APRN
-
Bianca Lambert, PA-C
-
Hannah Marie Norris, APRN
-
Gina Lori Bowlin, LCSW
-
Pamela W. Helton, ARNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D1084352 | Freeman Family Practice, LLC | Certificate of waiver | May 20, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 183964
- Legal name
- FREEMAN FAMILY PRACTICE LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 23, 2008
- Last certification
- Apr 16, 2015
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- May 9, 2008 in KY
- Enrollment address
- 10755 N. US Hwy 25E
Gray, KY 40734-6529
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Tammy L Freeman |
5% Or Greater Direct Ownership Interest |
May 1, 2008 | 100% |
| Lori Mullins |
W-2 Managing Employee |
Feb 3, 2014 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080613000081 | KY | Part B Supplier - Clinic/Group Practice | 8325119605 |
Receives reassigned benefits from 4 practitioners Practice locations: Gray, KY |
| O20080922000122 | KY | Part a Provider - Rural Health Clinic | 8325119605 | Practice locations: Gray, KY |
National Provider Directory
Locations
10755 N US Highway 25E
Gray, KY 40734
Phone (606) 215-1793
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 900220 | KY | Yes |
| Family Nurse Practitioner |
363LF0000X | 2597P | KY |
Addresses
Primary practice location
10755 N US Highway 25E
Gray, KY 40734-6529
Mailing address
10755 N US Highway 25E
Gray, KY 40734-6529
Phone (606) 258-8050
Other providers in Gray, KY
- Hannah Campbell Barger
- Veronica L Boley
- Erin Chadwell
- Crystal Ann Cooper
- Angela Eversole
- Tammy L Freeman
- Melissa Garland
- Natasha Garrison
- Rita Carol Gilbert
- Kristy Marie Keefe
All providers in Gray, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2014. 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.
- 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.