Healthcare Provider Details

I. General information

NPI: 1356580443
Provider Name (Legal Business Name): MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 09/10/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST STE 378W
MURRAY KY
42071-2400
US

IV. Provider business mailing address

300 S 8TH ST STE 378W
MURRAY KY
42071-2400
US

V. Phone/Fax

Practice location:
  • Phone: 270-753-5073
  • Fax: 270-767-3620
Mailing address:
  • Phone: 270-753-5073
  • Fax: 270-767-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31965
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1126
License Number StateKY

VIII. Authorized Official

Name: VICKIE L VEACH
Title or Position: CREDENTIALING
Credential: CPC
Phone: 502-814-3184