Healthcare Provider Details

I. General information

NPI: 1801929740
Provider Name (Legal Business Name): HAZARD ARH REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1331
  • Fax: 606-439-6629
Mailing address:
  • Phone: 606-439-1331
  • Fax: 606-439-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100365
License Number StateKY

VIII. Authorized Official

Name: JERRY HAYNES
Title or Position: PRESIDENT
Credential:
Phone: 606-439-1331