Healthcare Provider Details

I. General information

NPI: 1326596636
Provider Name (Legal Business Name): THE MEDICAL CENTER AT CLINTON COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 BURKESVILLE RD
ALBANY KY
42602-1604
US

IV. Provider business mailing address

PO BOX 8000
BOWLING GREEN KY
42102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 606-387-2066
  • Fax: 606-387-2067
Mailing address:
  • Phone: 270-745-1100
  • Fax: 270-745-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number730169
License Number StateKY

VIII. Authorized Official

Name: RONALD G SOWELL
Title or Position: EXEC. VICE PRESIDENT
Credential:
Phone: 270-745-1500