Provider Demographics
NPI:1770029126
Name:ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Other - Org Name:ARH CUMBERLAND VALLEY MEDICAL AND SURGICAL ASSOCIATES- BARBOURVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-226-2511
Mailing Address - Street 1:80 HOSPITAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7363
Mailing Address - Country:US
Mailing Address - Phone:606-545-4460
Mailing Address - Fax:606-545-4469
Practice Address - Street 1:80 HOSPITAL DR STE 2
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7363
Practice Address - Country:US
Practice Address - Phone:606-545-4460
Practice Address - Fax:606-545-4469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-10
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100459580Medicaid
K217350OtherMEDICARE PART B