GEORGETOWN MEDICAL, LLC
NPI 1063824381
Clinic/Center - Methadone in Georgetown, KY
About Georgetown Medical, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GEORGETOWN MEDICAL, LLC (NPI 1063824381) is a healthcare organization registered as a methadone in Georgetown, Kentucky and active in the NPI registry since May 2014. The organization holds a CLIA Waiver certificate valid through October 3, 2026, maintains a secondary practice location in Georgetown, and lists Robyn Tanis, Executive Director Of Contract Mgmt, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 18D2119759
Georgetown Medical, LLC · Georgetown, KYOther Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
GEORGETOWN, KY 40324
GEORGETOWN, KY 40324
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Georgetown Medical, LLC's NPI number?
The NPI number for Georgetown Medical, LLC is 1063824381. It was assigned to this organization in the NPPES registry on May 21, 2014.
Where is Georgetown Medical, LLC located?
Georgetown Medical, LLC is located at 105 Eastside Dr, Georgetown, KY 40324. The listed phone number is (502) 868-0664.
What is Georgetown Medical, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.
Does Georgetown Medical, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 18D2119759) is associated with this NPI, valid through October 3, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Georgetown Medical, LLC was last updated on September 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Georgetown Medical, Llc · NPI 1063824381
Methadone organization in Georgetown, Kentucky. Organization record, active in the CMS NPPES registry since May 21, 2014.
## Identity
- **NPI:** 1063824381 (Entity type: Organization)
- **Enumerated:** May 21, 2014
- **Primary specialty:** Clinic/Center - Methadone · taxonomy 261QM2800X
- **Organization subpart:** No
- **Authorized official:** Robyn Tanis, EXECUTIVE DIRECTOR OF CONTRACT MGMT
## Practice location
- **Address:** 105 EASTSIDE DR, Georgetown, KY 40324-9797
- **Phone:** (502) 868-0664
## Record status
- **NPPES last updated:** September 9, 2021
- **Other identifiers:** Other 810355 (KY)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063824381) · Data from the CMS NPPES public registry.