Basic Information
Provider Information
NPI: 1477038453
EntityType: 2
ReplacementNPI:  
OrganizationName: ASHALND HOSPITAL CORPORATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1595
Address2:  
City: ASHLAND
State: KY
PostalCode: 411051595
CountryCode: US
TelephoneNumber: 6064086200
FaxNumber: 6064086612
Practice Location
Address1: 617 23RD ST STE 8A
Address2:  
City: ASHLAND
State: KY
PostalCode: 411012845
CountryCode: US
TelephoneNumber: 6064081290
FaxNumber: 6064086640
Other Information
ProviderEnumerationDate: 09/26/2018
LastUpdateDate: 09/26/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WHITLATCH
AuthorizedOfficialFirstName: KRISTIE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO/PRESIDENT
AuthorizedOfficialTelephone: 6064084401
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
207LP2900X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine

No ID Information.


Home