Healthcare Provider Details

I. General information

NPI: 1689813594
Provider Name (Legal Business Name): MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 09/10/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 POWELL ST
BENTON KY
42025
US

IV. Provider business mailing address

300 S 8TH ST SUITE 480 WEST
MURRAY KY
42071-2400
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-0045
  • Fax: 270-527-0075
Mailing address:
  • Phone: 270-527-0045
  • Fax: 270-527-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02826
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02826
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1880P
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3315P
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1880P
License Number StateKY

VIII. Authorized Official

Name: TERESA CARPENTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-762-1281