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Organization
O C H INTERNAL MEDICINE
Active
Organization
O C H INTERNAL MEDICINE
Active
Other names
OCH Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DAUGHERTY (PFS DIRECTOR)
(270) 504-1910
Entity
Organization
Contact information
Practice address
1215 OLD MAIN ST, HARTFORD, KY 42347-1619
(270) 298-5404
(270) 298-5285
Mailing address
1215 OLD MAIN ST, HARTFORD, KY 42347-1619
(270) 298-5404
(270) 298-5285
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
34484
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000196674
BLUE CROSS AND CLUE SHIEL
KS
05
—
65922247
—
KY
01
—
G91153
MEDICARE UPIN NUMBER
KY
Enumeration date
07/17/2006
Last updated
03/19/2024
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