Provider Demographics
NPI:1790116390
Name:BRECKINRIDGE HEALTH INC
Entity Type:Organization
Organization Name:BRECKINRIDGE HEALTH INC
Other - Org Name:BRECKINRIDGE HEALTH INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-756-7000
Mailing Address - Street 1:1011 OLD US HWY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2575
Mailing Address - Country:US
Mailing Address - Phone:270-756-2424
Mailing Address - Fax:270-756-2525
Practice Address - Street 1:1011 OLD US HWY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2575
Practice Address - Country:US
Practice Address - Phone:270-756-2424
Practice Address - Fax:270-756-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940306Medicaid