Healthcare Provider Details

I. General information

NPI: 1033661749
Provider Name (Legal Business Name): MARCUM & WALLACE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MERCY CT
IRVINE KY
40336-1331
US

IV. Provider business mailing address

60 MERCY CT PO BOX 928
IRVINE KY
40336-1331
US

V. Phone/Fax

Practice location:
  • Phone: 606-726-2146
  • Fax: 606-723-2951
Mailing address:
  • Phone: 606-726-2146
  • Fax: 606-723-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05150
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SPILLE
Title or Position: SYSTEM DIRECTOR, RETAIL PHARMACY
Credential:
Phone: 513-952-5063