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SOUTHFORK MEDICAL CLINIC PLLC
NPI 1205616265
Clinic/Center - Rural Health in Whitley City, KY

Active since October 05, 2023
57 MEDICAL LANE, WHITLEY CITY, KY 42653(606) 376-7211(606) 376-9219 Get Directions Write a Review

NPPES record last updated: November 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 25, 2025, Apr 15, 2024, Oct 6, 2023 (3 updates tracked since 2023).

About Southfork Medical Clinic Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHFORK MEDICAL CLINIC PLLC (NPI 1205616265), doing business as South Fork Clinic Pllc, is a healthcare organization registered as a rural health in Whitley City, Kentucky and active in the NPI registry since October 2023. The organization lists Virginia Ann Correll, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1205616265
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameSOUTHFORK MEDICAL CLINIC PLLC
Location Address57 MEDICAL LANEWhitley City, KY 42653
Mailing AddressPo Box 490Whitley City, KY 42653-0490 · (606) 376-7211
Phone(606) 376-7211
Fax(606) 376-9219
Organization SubpartNo
Authorized OfficialVirginia Ann CorrellCredentialing · (606) 376-7212
Enumeration DateOctober 5, 2023
Last NPPES UpdateNovember 25, 20253 updates tracked since enumeration
NPPES CertifiedNovember 25, 2025
✔ NPI 1205616265 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
57 MEDICAL LANE, Whitley City, KY 42653
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Other Names 1

Doing Business AsSouth Fork Clinic Pllc

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 Accreditation 18D1005589

South Fork Medical Clinic, PLLC · Whitley City, KY
Expired · Jul 21, 2026
CLIA Number18D1005589
Laboratory TypePhysician Office
Certificate Effective DateJuly 22, 2024
Certificate Expiration DateJuly 21, 2026
Laboratory DirectorDr. Steven Thompson
Laboratory Phone(606) 376-7212
Laboratory LocationSouth Fork Medical Clinic, PLLC71 Medical Lane, Whitley City, KY 42653
CLIA data matches this NPI record on: Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

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 Southfork Medical Clinic PLLC's NPI number?

The NPI number for Southfork Medical Clinic PLLC is 1205616265. It was assigned to this organization in the NPPES registry on October 5, 2023. The provider is doing business as South Fork Clinic PLLC.

Where is Southfork Medical Clinic PLLC located?

Southfork Medical Clinic PLLC is located at 57 Medical Lane, Whitley City, KY 42653. The listed phone number is (606) 376-7211.

What is Southfork Medical Clinic PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

When was this NPI record last updated?

The NPPES record for Southfork Medical Clinic PLLC was last updated on November 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months 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.