=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841240090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAK TREE HOSPITAL AT BAPTIST NORTHEAST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 05/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 NEW MOODY LN
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-222-8506
-----------------------------------------------------
Fax | 502-222-8526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 NEW MOODY LN
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-222-8506
-----------------------------------------------------
Fax | 502-222-8526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | JOE MURRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-222-8506
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282E00000X
-----------------------------------------------------
Taxonomy Name | Long Term Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------