Healthcare Provider Details

I. General information

NPI: 1174743819
Provider Name (Legal Business Name): KNOX HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HOSPITAL DRIVE
BARBOURVILLE KY
40906
US

IV. Provider business mailing address

PO BOX 10 80 HOSPITAL DRIVE
BARBOURVILLE KY
40906
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-4175
  • Fax: 606-545-5511
Mailing address:
  • Phone: 606-546-4175
  • Fax: 606-545-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number600080
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number600080
License Number StateKY

VIII. Authorized Official

Name: KATHY R BROCK
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 606-545-4866