Provider Demographics
NPI:1720324023
Name:USP MCCREARY
Entity Type:Organization
Organization Name:USP MCCREARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING HEALTH SERVICES ADMINISTRATO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-354-7160
Mailing Address - Street 1:330 FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-7000
Mailing Address - Country:US
Mailing Address - Phone:606-354-7160
Mailing Address - Fax:606-354-7163
Practice Address - Street 1:330 FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-7000
Practice Address - Country:US
Practice Address - Phone:606-354-7160
Practice Address - Fax:606-354-7163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12669261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health