Healthcare Provider Details

I. General information

NPI: 1164158937
Provider Name (Legal Business Name): MAGUET MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MOONBOW PLZ STE 1
CORBIN KY
40701-8983
US

IV. Provider business mailing address

40 MOONBOW PLZ STE 1
CORBIN KY
40701-8983
US

V. Phone/Fax

Practice location:
  • Phone: 606-215-3488
  • Fax: 606-280-4015
Mailing address:
  • Phone: 606-215-3488
  • Fax: 606-280-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEVONNA MAGUET
Title or Position: OWNER
Credential: APRN
Phone: 606-215-3488