Basic Information
| Provider Information | |||||||||
| NPI: | 1386783868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARRISON MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 KY HIGHWAY 36 E | ||||||||
| Address2: | |||||||||
| City: | CYNTHIANA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410317498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592342300 | ||||||||
| FaxNumber: | 8592353699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 KY HIGHWAY 36 E | ||||||||
| Address2: | |||||||||
| City: | CYNTHIANA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410317498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592342300 | ||||||||
| FaxNumber: | 8592353699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | CURRANS | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592353503 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 100167 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363A00000X | 100167 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 261Q00000X | 100167 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 000000056932 | 01 | KY | ANTHEM ER PROF GRP # | OTHER | 65930224 | 05 | KY | MEDICAID | 7100346810 | 01 | KY | PA GROUP MEDICAID | OTHER | 7100346050 | 01 | KY | NP GROUP MEDICAID | OTHER | 0108 | 01 | KY | MEDICARE PTAN | OTHER | 000000063307 | 01 | KY | ANTHEM PROF SERV GRP ID | OTHER |