=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578552600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN E WARD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2005
-----------------------------------------------------
Last Update Date | 05/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 OLD MAIN ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42347-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-298-7411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 148
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42347-0148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-504-1910
-----------------------------------------------------
Fax | 270-298-3824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 28784
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number | 28784
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------