Healthcare Provider Details

I. General information

NPI: 1891803722
Provider Name (Legal Business Name): CAVERNA MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 MAIN ST
MUNFORDVILLE KY
42765-9432
US

IV. Provider business mailing address

PO BOX 340
MUNFORDVILLE KY
42765-0340
US

V. Phone/Fax

Practice location:
  • Phone: 270-524-3641
  • Fax: 270-524-7595
Mailing address:
  • Phone: 270-524-3641
  • Fax: 270-524-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number600065
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number600065
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900223
License Number StateKY

VIII. Authorized Official

Name: MR. ALAN ALEXANDER
Title or Position: CEO
Credential:
Phone: 270-786-2191