Healthcare Provider Details

I. General information

NPI: 1700013018
Provider Name (Legal Business Name): EPHRAIM MCDOWELL HEALTH RESOURCE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 LEBANON RD STE 1
DANVILLE KY
40422-9601
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-3208
  • Fax: 859-236-7991
Mailing address:
  • Phone: 859-239-2360
  • Fax: 859-239-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number700198
License Number StateKY

VIII. Authorized Official

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