NPIMap

Organization Active NPI

Glenn R. Womack M.D. PSC

  • Family Medicine Physician
  • Flemingsburg, KY
National Provider Identifier
1962432153
Registry record updated May 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15952 Issued in KY
Legal business name
GLENN R. WOMACK M.D. PSC
Practice address
732 Elizaville Road
Flemingsburg, KY 41041
Phone
(606) 849-2323
Fax
(606) 849-2025
NPI assigned
Jul 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2013

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

Authorized official

Name
Dr. Glenn R Womack, M.D.
Title
President
Phone
(606) 849-2323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 15952 KY Primary

Addresses

Primary practice location

732 Elizaville Road
Flemingsburg, KY 41041

Mailing address

732 Elizaville Road
PO Box 344
Flemingsburg, KY 41041
Phone (606) 849-2323

Other identifiers 3

IdentifierTypeStateIssuer
78904141MedicaidKY
9590108800MedicaidKY
65929143MedicaidKY

Other names 1

  • Buffalo Trace Family Health Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369094400000",
    "number": "1962432153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 ELIZAVILLE ROAD",
            "address_2": "PO BOX 344",
            "city": "FLEMINGSBURG",
            "state": "KY",
            "postal_code": "41041",
            "telephone_number": "606-849-2323",
            "fax_number": "606-849-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 ELIZAVILLE ROAD",
            "city": "FLEMINGSBURG",
            "state": "KY",
            "postal_code": "41041",
            "telephone_number": "606-849-2323",
            "fax_number": "606-849-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN R. WOMACK M.D. PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2013-05-21",
        "status": "A",
        "authorized_official_last_name": "WOMACK",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-849-2323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "15952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78904141",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9590108800",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65929143",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buffalo Trace Family Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flemingsburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.