| NPI | 1053964965 |
|---|---|
| Doing Business As | COMMUNITY CARE CLINIC |
| Entity Type | Organization |
| Authorized Contact | LOGAN ROY ANTLE CEO 606-425-5768 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 261QR1300X Clinic/Center, Rural Health | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2023-12-07 |