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NPI Code Detail

MEDICARE: MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES

MEDICARE: MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
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
1207Q00000XFamily Medicine Physician
2207RE0101XEndocrinology, Diabetes & Metabolism Physician
3207RP1001XPulmonary Disease Physician
42080A0000XPediatric Adolescent Medicine Physician
52084N0400XNeurology Physician
62085R0202XDiagnostic Radiology Physician
7208600000XSurgery Physician40293KY
8208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
9208M00000XHospitalist Physician
10207X00000XOrthopaedic Surgery Physician
11363LF0000XFamily Nurse Practitioner
12363AS0400XSurgical Physician Assistant
13261QR1300XRural Health Clinic/Center
14213ES0103XFoot & Ankle Surgery Podiatrist
15207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710951116
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Provider Business Mailing Address
First Line : 740 E LAUREL RD
Second Line :
City : LONDON
State : KY
Zip : 40741-8601
Country : US
Telephone Number : 606-330-7808
Fax Number : 606-330-7825
Provider Business Practice Location Address
First Line : 1001 SAINT JOSEPH LANE
Second Line :
City : LONDON
State : KY
Zip : 40741-8345
Country : US
Telephone Number : 606-330-6000
Fax Number : 606-330-7825
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : MRS. KANDI R REA
Credential :
Telephone Number : 606-330-7808
Provider Enumeration Date : 02/14/2006
Last Update Date : 06/13/2011

Similar Medicare Providers

1871452805 — DYLAN JAMES ANGIOLILLO RN
Practice Location Address:
1001 SAINT JOSEPH LN
LONDON, KY
40741-8345
Practice Phone: 606-330-6000
Practice Fax:
1992701429 — SAINT JOSEPH HEALTH SYSTEM, INC
Practice Location Address:
1001 SAINT JOSEPH LN
LONDON, KY
40741-8345
Practice Phone: 606-330-6000
Practice Fax: 606-330-6020
1699760884 — LAURA ALEXIS BRANNON CRNA
Practice Location Address:
1001 SAINT JOSEPH LN
LONDON, KY
40741-8345
Practice Phone: 606-330-6000
Practice Fax: 606-330-7825
1346214681 — DR. DEEPAK SRIVASTAVA M.D.
Practice Location Address:
1001 SAINT JOSEPH LN , ANESTHESIA PROGRAM
LONDON, KY
40741-8345
Practice Phone: 606-330-6906
Practice Fax: 606-330-6536
1962476200 — SATHYENDRA R MYSORE M.D.
Practice Location Address:
1001 SAINT JOSEPH LN
LONDON, KY
40741-8345
Practice Phone: 606-330-6000
Practice Fax: 606-330-7825
1407806318 — SHAILESH Y BHOPATKAR M.D.
Practice Location Address:
1001 SAINT JOSEPH LN
LONDON, KY
40741-8345
Practice Phone: 606-330-6000
Practice Fax: 606-330-7825

Directions to “MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES ” Practice Location

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