Organization
WHITAKER NATIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MOORE (CFO)
(415) 435-4591
Entity
Organization
Contact information
Practice address
625 JAMES TRIMBLE BLVD, PAINTSVILLE, KY 41240
(606) 789-3511
(606) 789-1432
Mailing address
PO BOX 936434, ATLANTA, GA 31193-6434
(800) 377-8721
(304) 697-1155
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061861
BCBS GROUP #
KY
05
—
0008085000
—
WV
05
—
2502198
—
OH
05
—
65932204
—
KY
01
—
CA8135
RR MEDICARE
—
Enumeration date
10/26/2005
Last updated
06/28/2018
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