Healthcare Provider Details

I. General information

NPI: 1497339857
Provider Name (Legal Business Name): MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST STE 107E
MURRAY KY
42071-2442
US

IV. Provider business mailing address

300 S 8TH ST STE 107E
MURRAY KY
42071-2442
US

V. Phone/Fax

Practice location:
  • Phone: 270-762-1512
  • Fax: 270-767-3605
Mailing address:
  • Phone: 270-762-1512
  • Fax: 270-762-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN BRADFORD
Title or Position: CFO/AO
Credential:
Phone: 270-762-1100