Healthcare Provider Details

I. General information

NPI: 1124794979
Provider Name (Legal Business Name): METHODIST HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

PO BOX 638706
CINCINNATI OH
45263-8706
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-7474
  • Fax: 270-830-4738
Mailing address:
  • Phone: 270-827-7474
  • Fax: 270-830-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE JENKINS
Title or Position: VP
Credential:
Phone: 270-827-7118