Healthcare Provider Details

I. General information

NPI: 1205214301
Provider Name (Legal Business Name): MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST STE 208E
MURRAY KY
42071-2472
US

IV. Provider business mailing address

300 S 8TH ST STE 480W
MURRAY KY
42071-2403
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9223
  • Fax: 270-753-7345
Mailing address:
  • Phone: 270-753-0704
  • Fax: 270-752-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN BRADFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 270-762-1104