Provider Demographics
NPI:1447446406
Name:CARROLLTON INTERNAL MEDICINE PSC
Entity type:Organization
Organization Name:CARROLLTON INTERNAL MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:502-525-2168
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-0266
Mailing Address - Country:US
Mailing Address - Phone:502-732-9922
Mailing Address - Fax:502-732-9050
Practice Address - Street 1:307 11TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-1435
Practice Address - Country:US
Practice Address - Phone:502-732-9922
Practice Address - Fax:502-732-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty