Provider Demographics
NPI:1164158937
Name:MAGUET MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MAGUET MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUET
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-215-3488
Mailing Address - Street 1:40 MOONBOW PLZ STE 1
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8983
Mailing Address - Country:US
Mailing Address - Phone:606-215-3488
Mailing Address - Fax:606-280-4015
Practice Address - Street 1:40 MOONBOW PLZ STE 1
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8983
Practice Address - Country:US
Practice Address - Phone:606-215-3488
Practice Address - Fax:606-280-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty