Basic Information
| Provider Information | |||||||||
| NPI: | 1477743003 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRECKINRIDGE HEALTH, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BRECKINRIDGE MEMORIAL ER PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 OLD HIGHWAY 60 | ||||||||
| Address2: | |||||||||
| City: | HARDINSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401432519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707567000 | ||||||||
| FaxNumber: | 2705802208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 OLD HIGHWAY 60 | ||||||||
| Address2: | |||||||||
| City: | HARDINSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401432519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707567000 | ||||||||
| FaxNumber: | 2705802208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARMAN | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MGR. | ||||||||
| AuthorizedOfficialTelephone: | 2707566564 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100050000 | 05 | KY | MEDICAID |