Healthcare Provider Details

I. General information

NPI: 1255357364
Provider Name (Legal Business Name): OUR LADY OF THE WAY HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11203 MAIN STREET
MARTIN KY
41649-0910
US

IV. Provider business mailing address

P.O BOX 910
MARTIN KY
41649-0910
US

V. Phone/Fax

Practice location:
  • Phone: 606-285-6400
  • Fax: 606-285-6629
Mailing address:
  • Phone: 606-285-6400
  • Fax: 606-285-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY STUMBO
Title or Position: CEO
Credential:
Phone: 606-285-6400