1215079124 NPI number — BAPTIST HEALTH DEACONESS MADISONVILLE INC

Table of content: MRS. ELIZABETH ANN CLARK FNP (NPI 1346604584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215079124 NPI number — BAPTIST HEALTH DEACONESS MADISONVILLE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST HEALTH DEACONESS MADISONVILLE 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:
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:
1215079124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-1653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-824-3470
Provider Business Mailing Address Fax Number:
270-824-3468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CLINIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-824-3470
Provider Business Practice Location Address Fax Number:
270-824-3468
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARRICO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
502-896-5006

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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