Provider Demographics
NPI:1295833861
Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL DBA PHYS SPECIALISTS OF MURRAY
Entity Type:Organization
Organization Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL DBA PHYS SPECIALISTS OF MURRAY
Other - Org Name:CHARETTE AND MORGAN ORTHOPAEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-762-1281
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-761-5756
Mailing Address - Fax:270-767-3665
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 284W
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-761-5756
Practice Address - Fax:270-767-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20499207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS64204993Medicaid
KY0000047418OtherANTHEM BLUE CROSS
KS64204993Medicaid
KY0000047418OtherANTHEM BLUE CROSS
C74091Medicare UPIN