MEDICARE: BARREN RIVER REGIONAL CANCER CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471R0002X	Radiation Therapy Radiologic Technologist	730074	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700860319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARREN RIVER REGIONAL CANCER CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 117916
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7916
Country	:	US
Telephone Number	:	270-745-1467
Fax Number	:	270-745-1417

Provider Business Practice Location Address
First Line	:	103 TRISTA LN
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-3482
Country	:	US
Telephone Number	:	270-651-2478
Fax Number	:	270-651-9264

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	CONNIE D. SMITH
Credential	:
Telephone Number	:	270-745-1262

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	06/06/2026

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