Provider Demographics
NPI:1255505087
Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Other - Org Name:MARSHALL COUNTY FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:270-762-1780
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480 WEST
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1780
Mailing Address - Fax:270-762-1783
Practice Address - Street 1:543 POWELL LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5366
Practice Address - Country:US
Practice Address - Phone:270-527-2273
Practice Address - Fax:270-527-9602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MURRAY CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-14
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30462207Q00000X
KY3142P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYNP 7100089890Medicaid
KYMD 7100050070Medicaid
KYMD 7100050070Medicaid
KYP16698Medicare UPIN