MEDICARE: O C H INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	34484	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G91153	OTHER	KY	MEDICARE UPIN NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000196674	OTHER	KS	BLUE CROSS AND CLUE SHIEL

General Provider Information

NPI Number	:	1164440426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O C H INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	1215 OLD MAIN ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1619
Country	:	US
Telephone Number	:	270-298-5404
Fax Number	:	270-298-5285

Provider Business Practice Location Address
First Line	:	1215 OLD MAIN ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1619
Country	:	US
Telephone Number	:	270-298-5404
Fax Number	:	270-298-5285

Authorized Official
Title or Position	:	PFS DIRECTOR
Name	:	JENNIFER DAUGHERTY
Credential	:
Telephone Number	:	270-504-1910

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/19/2024

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Directions to “O C H INTERNAL MEDICINE ” Practice Location

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