Healthcare Provider Details

I. General information

NPI: 1205188208
Provider Name (Legal Business Name): EPHRAIM MCDOWELL H EALTH RESOURCE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 BEN ALI DR
DANVILLE KY
40422-8937
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-2312
  • Fax:
Mailing address:
  • Phone: 859-239-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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