Basic Information
| Provider Information | |||||||||
| NPI: | 1831172683 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METHODIST HEALTH, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | METHODIST HOSPITAL UNION COUNTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 638705 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452638705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708277558 | ||||||||
| FaxNumber: | 2708277530 | ||||||||
| Practice Location | |||||||||
| Address1: | 4604 US HIGHWAY 60 W | ||||||||
| Address2: | |||||||||
| City: | MORGANFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424376515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703895000 | ||||||||
| FaxNumber: | 2703895059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | NOLEN | ||||||||
| AuthorizedOfficialFirstName: | BENNY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2708277700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 600057 | KY | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 000000054530 | 01 | KY | ANTHEM BCBS | OTHER | 7100008350 | 05 | KY | MEDICAID |