Healthcare Provider Details

I. General information

NPI: 1336233212
Provider Name (Legal Business Name): GALLATIN HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CENTER STREET
WARSAW KY
41095-0968
US

IV. Provider business mailing address

PO BOX 968 499 CENTER STREET
WARSAW KY
41095-0968
US

V. Phone/Fax

Practice location:
  • Phone: 859-567-4548
  • Fax: 859-567-5264
Mailing address:
  • Phone: 859-567-4548
  • Fax: 859-567-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100632
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100632
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number100632
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100632
License Number StateKY

VIII. Authorized Official

Name: MR. MARK BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 859-272-6682