Provider Demographics
NPI:1881619468
Name:OUR LADY OF THE WAY HOSPITAL.
Entity type:Organization
Organization Name:OUR LADY OF THE WAY HOSPITAL.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-285-6602
Mailing Address - Street 1:11203 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-0910
Mailing Address - Country:US
Mailing Address - Phone:606-285-6400
Mailing Address - Fax:606-285-6629
Practice Address - Street 1:11551 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-0910
Practice Address - Country:US
Practice Address - Phone:606-285-3733
Practice Address - Fax:606-285-6629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF THE WAY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35000827Medicaid
KY183442Medicare PIN