Healthcare Provider Details

I. General information

NPI: 1679721823
Provider Name (Legal Business Name): MUHLENBERG MEDICAL PROPERTY VI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MEDICAL CENTER DR
POWDERLY KY
42367-5463
US

IV. Provider business mailing address

1010 MEDICAL CENTER DR
POWDERLY KY
42367-5463
US

V. Phone/Fax

Practice location:
  • Phone: 270-377-1600
  • Fax: 270-338-0229
Mailing address:
  • Phone: 270-377-1600
  • Fax: 270-338-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS RANDALL POWELL
Title or Position: CEO
Credential:
Phone: 270-377-1600