Healthcare Provider Details

I. General information

NPI: 1316994080
Provider Name (Legal Business Name): MARY BRECKINRIDGE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
HYDEN KY
41749-8957
US

IV. Provider business mailing address

100 HOSPITAL DR
HYDEN KY
41749-8957
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-2901
  • Fax: 606-672-3626
Mailing address:
  • Phone: 606-672-2901
  • Fax: 606-672-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number60067
License Number StateKY

VIII. Authorized Official

Name: MRS. MALLIE S. NOBLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-672-3162