1417002114 NPI number — EPHRAIM MCDOWELL HEALTH RESOURCE, INC.

Table of content: (NPI 1417002114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417002114 NPI number — EPHRAIM MCDOWELL HEALTH RESOURCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPHRAIM MCDOWELL HEALTH RESOURCE, 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:
1417002114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40423-0990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-548-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N CAMP DICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-548-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SNAPP
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
859-239-1000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  900099 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35001148 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com