Healthcare Provider Details

I. General information

NPI: 1659454924
Provider Name (Legal Business Name): MORGAN-HAUGH PROFESSIONAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL CENTER CIR
MAYFIELD KY
42066-1194
US

IV. Provider business mailing address

1111 MEDICAL CENTER CIR
MAYFIELD KY
42066-1194
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-8100
  • Fax: 270-247-7780
Mailing address:
  • Phone: 270-247-8100
  • Fax: 270-247-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41115
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00328
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number917
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number27345
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2813P
License Number StateKY

VIII. Authorized Official

Name: MR. MARTIN P BRAAKSMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-650-7138