Healthcare Provider Details

I. General information

NPI: 1699072967
Provider Name (Legal Business Name): MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

740 E LAUREL RD
LONDON KY
40741-8601
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-0770
  • Fax: 606-864-1461
Mailing address:
  • Phone: 859-276-6611
  • Fax: 859-276-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. CARMEL JONES
Title or Position: COO/VP FINANCE
Credential:
Phone: 606-330-6015