Basic Information
Provider Information | |||||||||
NPI: | 1588069785 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | EPHRAIM MCDOWELL HEALTH RESOURCE, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | EM NEUROSCIENCE FRANKFORT | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 990 | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 404230990 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8592392360 | ||||||||
FaxNumber: | 8592396785 | ||||||||
Practice Location | |||||||||
Address1: | 160 KINGS DAUGHTERS DR | ||||||||
Address2: |   | ||||||||
City: | FRANKFORT | ||||||||
State: | KY | ||||||||
PostalCode: | 406014255 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5026059956 | ||||||||
FaxNumber: | 5026059958 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/30/2014 | ||||||||
LastUpdateDate: | 02/02/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SNAPP | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | VP | ||||||||
AuthorizedOfficialTelephone: | 8592392424 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | III | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173F00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Sleep Specialist, PhD |   | 204D00000X |   |   | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |   |
No ID Information.