=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205025301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO COUNTY HOSPITAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1520 N MAIN ST
-----------------------------------------------------
City | BEAVER DAM
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42320-8960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-274-7112
-----------------------------------------------------
Fax | 270-274-7698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 148 1520 NORTH MAIN STREET
-----------------------------------------------------
City | BEAVER DAM
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-274-7112
-----------------------------------------------------
Fax | 270-274-7698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PFS DIRECTOR
-----------------------------------------------------
Name | JENNIFER DAUGHERTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-504-1910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------