Healthcare Provider Details

I. General information

NPI: 1396949756
Provider Name (Legal Business Name): BALLARD COUNTY MEDICAL CENTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SOUTH 4TH STREET
BARLOW KY
42024
US

IV. Provider business mailing address

PO BOX 7287
PADUCAH KY
42002-7287
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-8999
  • Fax: 270-534-1670
Mailing address:
  • Phone: 270-534-8999
  • Fax: 270-534-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02888
License Number StateKY

VIII. Authorized Official

Name: MR. RANDY L TREECE
Title or Position: ATTORNEY AND CPA
Credential:
Phone: 270-534-8999