Provider Demographics
NPI:1144478710
Name:ALLEN FAMILY CLINIC PLLC.
Entity type:Organization
Organization Name:ALLEN FAMILY CLINIC PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:606-874-1444
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:KY
Mailing Address - Zip Code:41601-0262
Mailing Address - Country:US
Mailing Address - Phone:606-874-1444
Mailing Address - Fax:606-874-1446
Practice Address - Street 1:27 BALLPARK ST
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:KY
Practice Address - Zip Code:41601
Practice Address - Country:US
Practice Address - Phone:606-874-1444
Practice Address - Fax:606-874-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3251P261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013828Medicaid