Basic Information
| Provider Information | |||||||||
| NPI: | 1316141351 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED | ||||||||
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| OtherOrganizationName: | EPHRAIM MCDOWELL PROFEES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404221823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592391000 | ||||||||
| FaxNumber: | 8592396785 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404221823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592391000 | ||||||||
| FaxNumber: | 8592396785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | SNAPP | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8592391000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LA2100X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 282N00000X | 100034 | KY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 65935454 | 05 | KY | MEDICAID |