Provider Demographics
NPI:1336580554
Name:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INCORPPORATED
Entity Type:Organization
Organization Name:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INCORPPORATED
Other - Org Name:EPHRAIM MCDOWELL CANCER SUPPORT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNAPP
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:859-239-2424
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-1108
Mailing Address - Country:US
Mailing Address - Phone:859-239-2360
Mailing Address - Fax:
Practice Address - Street 1:520 TECHWOOD DR N
Practice Address - Street 2:STE 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8500
Practice Address - Country:US
Practice Address - Phone:859-236-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-16
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty