1104032754 NPI number — IRELAND ARMY COMMUNITY HOSPITAL

Table of content: (NPI 1104032754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104032754 NPI number — IRELAND ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRELAND ARMY COMMUNITY 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:
6
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:
1104032754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
289 IRELAND AVE
Provider Second Line Business Mailing Address:
ATTN: TREASURERS OFFICE
Provider Business Mailing Address City Name:
FORT KNOX
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40121-5111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-624-9274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2091 KINGSTON HWY
Provider Second Line Business Practice Location Address:
ATTN BLUE GRASS HEALTH CLINIC
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-9333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORNBACK
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO MANAGER
Authorized Official Telephone Number:
502-624-9870

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1891899274 . This is a "PARENT FACILITY IRELAND ACH NPI" identifier . This identifiers is of the category "OTHER".




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