Provider Demographics
NPI:1093040032
Name:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED
Entity Type:Organization
Organization Name:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED
Other - Org Name:MEDSOURCE OF STANFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNAPP
Authorized Official - Suffix:III
Authorized Official - Credentials:CPA
Authorized Official - Phone:859-239-1000
Mailing Address - Street 1:110 METKER TRL
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1020
Mailing Address - Country:US
Mailing Address - Phone:606-365-4632
Mailing Address - Fax:606-365-4637
Practice Address - Street 1:110 METKER TRL
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1020
Practice Address - Country:US
Practice Address - Phone:606-365-4632
Practice Address - Fax:606-365-4637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY040629332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90020116Medicaid
KY90020116Medicaid