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Organization
MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Active
Organization
MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KANDI R REA (CREDENTIALING SPECIALIST)
(606) 330-7808
Entity
Organization
Contact information
Practice address
1001 SAINT JOSEPH LANE, LONDON, KY 40741-8345
(606) 330-6000
(606) 330-7825
Mailing address
740 E LAUREL RD, LONDON, KY 40741-8601
(606) 330-7808
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
40293
KY
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
NULL
208M00000X
Hospitalist Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
261QR1300X
Rural Health Clinic/Center
—
NULL
363AS0400X
Surgical Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/14/2006
Last updated
06/13/2011
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