Basic Information
| Provider Information | |||||||||
| NPI: | 1336233212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GALLATIN HEALTH CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 968 | ||||||||
| Address2: | 499 CENTER STREET | ||||||||
| City: | WARSAW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410950968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595674548 | ||||||||
| FaxNumber: | 8595675264 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 CENTER STREET | ||||||||
| Address2: | |||||||||
| City: | WARSAW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410950968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595674548 | ||||||||
| FaxNumber: | 8595675264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | BOWMAN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592726682 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 100632 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | 100632 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 335E00000X | 100632 | KY | N | Suppliers | Prosthetic/Orthotic Supplier | 332BN1400X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 314000000X | 100632 | KY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 12502167 | 05 | KY | MEDICAID | 000000054848 | 01 | KY | ANTHEM BC/BS | OTHER |