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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
THREE RIVERS MEDICAL CENTER, 2483 HIGHWAY 644, LOUISA, KY 41230
(606) 638-9451
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
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000061861
BCBS GROUP #
KY
05
0008085000
WV
05
2065714
OH
05
65921785
KY
05
7100009960
KY
01
CA8135
RR MEDICARE
Enumeration date
11/08/2005
Last updated
06/28/2018
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