# O C H INTERNAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OCH Internal Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164440426
- **Authorized official:** JENNIFER DAUGHERTY (PFS DIRECTOR)
- **Authorized official phone:** (270) 504-1910

## Contact information

- **Practice address:** 1215 OLD MAIN ST, HARTFORD, KY 42347-1619
- **Practice address phone:** (270) 298-5404
- **Practice address fax:** (270) 298-5285
- **Mailing address:** 1215 OLD MAIN ST, HARTFORD, KY 42347-1619
- **Mailing address phone:** (270) 298-5404
- **Mailing address fax:** (270) 298-5285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 34484 | KY | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 03/19/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000196674 | BLUE CROSS AND CLUE SHIEL | KS |
| 05 | — | 65922247 | — | KY |
| 01 | — | G91153 | MEDICARE UPIN NUMBER | KY |