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General NPI Number Information
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NPI Number | 1720459282
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Entity Type | Organization
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Legal Business Name | FEDERAL CORRECTIONAL INSITUTION
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 805 FOX HOLLOW RD
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City | MANCHESTER
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State | KY
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Zip | 40962-7923
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Country | US
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Telephone | 606-598-1900
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Fax | 606-599-4196
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Provider Business Mailing Address
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Address Line | 805 FOX HOLLOW RD
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City | MANCHESTER
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State | KY
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Zip | 40962-7923
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Country | US
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Telephone | 606-598-1900
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Fax | 606-599-4196
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Authorized Official
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Title or Position | HEALTH SERVICES ADMINISTRATOR
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Name | ANGEL WILSON
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Credential | HSA
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Telephone | 606-598-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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