Healthcare Provider Details

I. General information

NPI: 1205499225
Provider Name (Legal Business Name): EPHRAIM MCDOWELL HEALTH RESOURCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 LEBANON RD STE 2
DANVILLE KY
40422-9601
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-4510
  • Fax: 859-239-4516
Mailing address:
  • Phone: 859-239-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM M SNAPP
Title or Position: EVP/CFO
Credential:
Phone: 859-239-2424