Provider Demographics
NPI:1053964965
Name:FAITH HEALTHCARE INC
Entity type:Organization
Organization Name:FAITH HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-425-5768
Mailing Address - Street 1:521 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-9503
Mailing Address - Country:US
Mailing Address - Phone:066-425-5768
Mailing Address - Fax:606-425-5769
Practice Address - Street 1:126 FRANKLIN DRIVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633
Practice Address - Country:US
Practice Address - Phone:606-685-6131
Practice Address - Fax:606-685-6179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-19
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty