Healthcare Provider Details

I. General information

NPI: 1629459912
Provider Name (Legal Business Name): EPHRAIM MCDOWELL HEALTH RESOURCES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 JT PETTY DRIVE STE 300
RUSSELL SPRINGS KY
42642
US

IV. Provider business mailing address

230 W MAIN ST STE 102
DANVILLE KY
40422-1871
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-9670
  • Fax: 859-236-7656
Mailing address:
  • Phone: 859-236-9670
  • Fax: 859-236-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM M SNAPP III
Title or Position: CFO/VP
Credential:
Phone: 859-239-2424