Basic Information
| Provider Information | |||||||||
| NPI: | 1083797278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCDOWELL APPALACHIAN REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 AIRPORT GARDENS RD | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062165145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9879 KY ROUTE 122 | ||||||||
| Address2: | |||||||||
| City: | MC DOWELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416476026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063773401 | ||||||||
| FaxNumber: | 6063773494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | HOLLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592262511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 05/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 100860 | KY | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 000000063662 | 01 | KY | BLUE CROSS REF LAB | OTHER |