Provider Demographics
| NPI: | 1093988388 |
|---|---|
| Name: | MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION |
| Entity type: | Organization |
| Organization Name: | MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
| 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: | 270-762-1104 |
| Mailing Address - Street 1: | 300 S 8TH ST |
| Mailing Address - Street 2: | STE 480W |
| Mailing Address - City: | MURRAY |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 42071-2400 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 270-753-0704 |
| Mailing Address - Fax: | 270-752-2852 |
| Practice Address - Street 1: | 300 S 8TH ST STE 380W |
| Practice Address - Street 2: | |
| Practice Address - City: | MURRAY |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 42071-2442 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 270-753-0704 |
| Practice Address - Fax: | 270-752-2852 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2008-04-08 |
| Last Update Date: | 2024-11-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207R00000X, 208M00000X, 363AM0700X, 363L00000X, 363LF0000X, 364S00000X, 103T00000X, 207Q00000X, 261QM1300X, 261QM1300X | ||
| KY | 39165 | 207X00000X |
| KY | 42219 | 208000000X |
| KY | TP985 | 2084N0400X |
| KY | 4250P | 363L00000X |
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 | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 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 |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100058500 | Medicaid | |
| KY | 7100695300 | Medicaid | |
| KY | 00656 | Other | MEDICARE PTAN |
| KY | 7100092150 | Medicaid |
