Healthcare Provider Details

I. General information

NPI: 1750790069
Provider Name (Legal Business Name): EPHRAIM MCDOWELL HEALTH RESOURCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PORTMAN AVE
STANFORD KY
40484-1229
US

IV. Provider business mailing address

125 PORTMAN AVE
STANFORD KY
40484-1229
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-3378
  • Fax: 606-365-3381
Mailing address:
  • Phone: 606-365-3378
  • Fax: 606-365-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL MCKAY III
Title or Position: CEO
Credential:
Phone: 859-239-2409