Provider Demographics
NPI: | 1629202858 |
---|---|
Name: | MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION |
Entity Type: | Organization |
Organization Name: | MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION |
Other - Org Name: | PHYSICIAN SPECIALIST OF MURRAY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BRADFORD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 270-762-1100 |
Mailing Address - Street 1: | 300 S 8TH ST STE 480W |
Mailing Address - Street 2: | |
Mailing Address - City: | MURRAY |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 42071-2403 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 270-762-1100 |
Mailing Address - Fax: | 270-767-3657 |
Practice Address - Street 1: | 300 S 8TH ST STE 203E |
Practice Address - Street 2: | |
Practice Address - City: | MURRAY |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42071-2400 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-762-1562 |
Practice Address - Fax: | 270-767-3633 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-01 |
Last Update Date: | 2024-01-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 01004 | Other | MEDICARE PTAN |
KY | 7100183220 | Medicaid | |
KY | 7100096520 | Medicaid | |
KY | 7100389760 | Medicaid |