Provider Demographics
NPI:1437482072
Name:EPHRAIM MCDOWELL HEALTH RESOURCE, INC.
Entity Type:Organization
Organization Name:EPHRAIM MCDOWELL HEALTH RESOURCE, INC.
Other - Org Name:EPHRAIM MCDOWELL VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:859-239-1000
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0990
Mailing Address - Country:US
Mailing Address - Phone:859-239-1000
Mailing Address - Fax:
Practice Address - Street 1:216 WEST WALNUT
Practice Address - Street 2:SUITE B
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1824
Practice Address - Country:US
Practice Address - Phone:859-239-4840
Practice Address - Fax:859-239-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG6967OtherRR MED