Basic Information
| Provider Information | |||||||||
| NPI: | 1629459912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPHRAIM MCDOWELL HEALTH RESOURCES,INC | ||||||||
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| OtherOrganizationName: | EM UROLOGY, RS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 W MAIN ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404221871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592369670 | ||||||||
| FaxNumber: | 8592367656 | ||||||||
| Practice Location | |||||||||
| Address1: | 92 JT PETTY DRIVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | RUSSELL SPRINGS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592369670 | ||||||||
| FaxNumber: | 8592367656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2015 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | SNAPP | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/VP | ||||||||
| AuthorizedOfficialTelephone: | 8592392424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 208800000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.