1417264060 NPI number — METHODIST HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417264060 NPI number — METHODIST HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST HEALTH, INC.
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:
METHODIST COMPREHENSIVE CARE
Provider Other Organization Name Type Code:
3
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:
1417264060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-827-7558
Provider Business Mailing Address Fax Number:
270-827-7530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42420-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-826-4646
Provider Business Practice Location Address Fax Number:
270-826-4647
Provider Enumeration Date:
09/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NOLEN
Authorized Official First Name:
BENNY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
270-827-7500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100144540 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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