SOUTHFORK MEDICAL CLINIC PLLC
NPI 1205616265
Clinic/Center - Rural Health in Whitley City, KY
- Organization
- Clinic/Center
- Rural Health
- CLIA Number: 18D1005589
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 07-21-2026
About SOUTHFORK MEDICAL CLINIC PLLC
This page provides the complete NPI Profile along with additional information for Southfork Medical Clinic Pllc, a primary care provider established in Whitley City, Kentucky operating as a Clinic/center, focusing in rural health . The healthcare provider is registered in the NPI registry with number 1205616265 assigned on October 2023. The practitioner's primary taxonomy code is 261QR1300X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Virginia Ann Correll (Credentialing)
- NPI
- 1205616265 Verify this NPI
- Provider Name
- SOUTHFORK MEDICAL CLINIC PLLC
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 57 MEDICAL LANE WHITLEY CITY, KY 42653
- Location Phone
- (606) 376-7211
- Location Fax
- (606) 376-9219
- Mailing Address
- PO BOX 490 WHITLEY CITY, KY 42653
- Mailing Phone
- (606) 376-7211
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-05-2023
- Last Update Date
- 11-25-2025
- Code Navigator
A primary care provider (PCP) like Southfork Medical Clinic Pllc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Rural Health
- Taxonomy Code
- 261QR1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 18D1005589
- Facility Type
- Physician Office
- Certificate Effective Date
- July 22, 2024
- Certificate Expiration Date
- July 21, 2026
- Laboratory Director
- DR. STEVEN THOMPSON
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Southfork Medical Clinic Pllc on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1205616265, enumerated as an "organization" on October 05, 2023.
The provider is located at 57 MEDICAL LANE WHITLEY CITY, KY 42653 and the phone number is (606) 376-7211.
Clinic/Center with taxonomy code 261QR1300X and a focus in Rural Health.
