Healthcare Provider Details

I. General information

NPI: 1225238512
Provider Name (Legal Business Name): WESTLAKE REGIONAL HOSPITAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WESTLAKE DR
COLUMBIA KY
42728-1123
US

IV. Provider business mailing address

901 WESTLAKE DR PO BOX 1269
COLUMBIA KY
42728-1123
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-4753
  • Fax: 270-385-9123
Mailing address:
  • Phone: 270-384-4753
  • Fax: 270-385-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number100001
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number100001
License Number StateKY

VIII. Authorized Official

Name: MR. NEAL M. GOLD
Title or Position: CEO
Credential:
Phone: 270-384-4753