=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558886705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARDIN MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2017
-----------------------------------------------------
Last Update Date | 10/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 534 HILLCREST DR
-----------------------------------------------------
City | BRANDENBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40108-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-422-5000
-----------------------------------------------------
Fax | 270-422-5052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 534 HILLCREST DR
-----------------------------------------------------
City | BRANDENBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40108-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-422-5000
-----------------------------------------------------
Fax | 270-422-5052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JEFFREY KINGERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-706-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------