Healthcare Provider Details

I. General information

NPI: 1558242255
Provider Name (Legal Business Name): ASHLAND HOSPITAL COPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 23RD ST STE 212
ASHLAND KY
41101-2883
US

IV. Provider business mailing address

617 23RD ST STE 212
ASHLAND KY
41101-2883
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-8485
  • Fax: 606-324-1351
Mailing address:
  • Phone: 606-408-8485
  • Fax: 606-324-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE D NIEMER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 606-408-9565