Provider Demographics
NPI:1689813594
Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Other - Org Name:ALBERTSON FAMILY MEDICAL
Other - Org Type:Doing Business As
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:702-762-1281
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:270-527-0045
Mailing Address - Fax:270-527-0075
Practice Address - Street 1:543 POWELL ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:270-527-0045
Practice Address - Fax:270-527-0075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MURRAY CALLOWAY COUNTY PUBLIC HOSPTIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-17
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
KY02826207R00000X, 208000000X
KY1880P363L00000X, 363LP0200X
KY3315P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100094200Medicaid
KY7100094200Medicaid