=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336580554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INCORPPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2013
-----------------------------------------------------
Last Update Date | 09/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 TECHWOOD DR N STE 100
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40422-8500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-236-2203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1108
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40423-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-239-2360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. WILLIAM M SNAPP III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-239-2424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------