Georgetown Medical, LLC
Clinic/Center, Methadone Clinic in Georgetown, Kentucky
1063824381- Practice location
- 105 Eastside Dr, Georgetown, KY 40324-9797
- Phone
- 502-868-0664
- Fax
- —
- Last updated
- September 10, 2026
Georgetown Medical, LLC is a healthcare organization based in Georgetown, KY. Georgetown Medical, LLC practices in Georgetown, KY. The NPI Number for Georgetown Medical, LLC is 1063824381 and holds a License No. 810355 (KY). The current practice location address for Georgetown Medical, LLC is 105 Eastside Dr, Georgetown, KY 40324-9797 and can be reached out via phone at 502-868-0664.
Provider Profile Details
- NPI Number
- 1063824381
- Provider Name
- Georgetown Medical, LLC
- Provider Entity Type
- Organization
- Address
- 105 Eastside Dr, Georgetown, KY 40324-9797
- Phone Number
- 502-868-0664
- Primary Taxonomy
- Clinic/Center, Methadone Clinic · 261QM2800X
- Organization Subpart
- No
- Authorized Official
- Robyn Tanis · Executive Director Of Contract Mgmt · 856-533-8762
- Provider Enumeration Date
- May 21, 2014
- Last Update Date
- September 10, 2026
- Certification Date
- September 10, 2026
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 105 Eastside Dr
Georgetown, KY 40324-9797 - City
- Georgetown
- State
- Kentucky
- Zip
- 40324-9797
- Phone Number
- 502-868-0664
Provider Business Mailing Address Details
- Address
- 1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202 - City
- Mount Laurel
- State
- NJ
- Zip
- 08054-2202
- Phone Number
- 856-439-6111
License Information
- License Number (1)
- 810355
- License State (1)
- KY
- Taxonomy (1)
- Clinic/Center, Methadone Clinic · 261QM2800X · Primary
- Taxonomy (2)
- Clinic/Center, Recovery Care · 261QR0800X
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Georgetown Medical, LLC?
The NPI number of Georgetown Medical, LLC is 1063824381. It was assigned on May 21, 2014 and is currently active in the NPPES registry.
What is the specialty of Georgetown Medical, LLC?
Georgetown Medical, LLC is registered under the primary taxonomy Clinic/Center, Methadone Clinic (code 261QM2800X), licensed in KY under license number 810355.
Where does Georgetown Medical, LLC practice?
The practice location is 105 Eastside Dr, Georgetown, KY 40324-9797. The office can be reached at 502-868-0664 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1063824381 directly on the NPPES registry website.