Provider Demographics
NPI:1477743003
Name:BRECKINRIDGE HEALTH, INC.
Entity Type:Organization
Organization Name:BRECKINRIDGE HEALTH, INC.
Other - Org Name:BRECKINRIDGE MEMORIAL ER PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-756-6564
Mailing Address - Street 1:1011 OLD HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2519
Mailing Address - Country:US
Mailing Address - Phone:270-756-7000
Mailing Address - Fax:270-580-2208
Practice Address - Street 1:1011 OLD HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2519
Practice Address - Country:US
Practice Address - Phone:270-756-7000
Practice Address - Fax:270-580-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207P00000X
261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100050000Medicaid
KY65941817Medicaid