| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number B03837 | (X3) Date Survey Completed 03/25/2021 |
| Name of Provider or Supplier Kentucky Family Medicine | Street Address, City, State 706 Manor St, Corbin, KY | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| J0000 | An initial certification survey was conducted on 03/25/2021. Standard level deficient practice was identified. |