Provider Demographics
NPI:1124084488
Name:HILLTOP PRIMARY CARE, INC
Entity type:Organization
Organization Name:HILLTOP PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-835-9333
Mailing Address - Street 1:7617 UPPER JOHNS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:KY
Mailing Address - Zip Code:41553-8775
Mailing Address - Country:US
Mailing Address - Phone:606-835-9333
Mailing Address - Fax:606-835-9997
Practice Address - Street 1:7617 UPPER JOHNS CREEK RD
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:KY
Practice Address - Zip Code:41553-8775
Practice Address - Country:US
Practice Address - Phone:606-835-9333
Practice Address - Fax:606-835-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 291U00000X, 363L00000X
KY900167261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45001880Medicaid
KY78903309Medicaid
KY35001973Medicaid
KY78903309Medicaid
KY183943Medicare Oscar/Certification