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General NPI Number Information
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NPI Number | 1255357364
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Entity Type | Organization
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Legal Business Name | OUR LADY OF THE WAY HOSPITAL, INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 11203 MAIN STREET
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City | MARTIN
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State | KY
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Zip | 41649-0910
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Country | US
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Telephone | 606-285-6400
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Fax | 606-285-6629
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Provider Business Mailing Address
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Address Line | P.O BOX 910
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City | MARTIN
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State | KY
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Zip | 41649-0910
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Country | US
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Telephone | 606-285-6400
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Fax | 606-285-6629
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Authorized Official
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Title or Position | CEO
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Name | MRS. KATHY STUMBO
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Credential |
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Telephone | 606-285-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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