1215066386 NPI number — FLEMINGSBURG HOSPITAL

Table of content: DANIELLE VICTORIA MAMOLA CRNA (NPI 1508755992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215066386 NPI number — FLEMINGSBURG HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLEMINGSBURG HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215066386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 ELIZAVILLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLEMINGSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41041-9209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-845-9507
Provider Business Mailing Address Fax Number:
606-849-5284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 ELIZAVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMINGSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41041-9209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-845-9507
Provider Business Practice Location Address Fax Number:
606-849-5284
Provider Enumeration Date:
03/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
UROLOGIST
Authorized Official Telephone Number:
859-277-5766

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)