1316363112 NPI number — MARTIN COUNTY RURAL HEALTH CLINIC PLLC

Table of content: (NPI 1316363112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316363112 NPI number — MARTIN COUNTY RURAL HEALTH CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN COUNTY RURAL HEALTH CLINIC PLLC
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:
1316363112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 697
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-0697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-886-1173
Provider Business Mailing Address Fax Number:
606-886-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 KIRK PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-2520
Provider Business Practice Location Address Fax Number:
606-298-2522
Provider Enumeration Date:
03/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HANA
Authorized Official First Name:
ANTOIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-886-1173

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64126055 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com