Organization
OUR LADY OF THE WAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH SHELTON (DIRECTOR BUSINESS OFFICE)
(606) 285-6601
Entity
Organization
Contact information
Practice address
11203 MAIN ST, MARTIN, KY 41649-0910
(606) 285-6400
(606) 285-6619
Mailing address
PO BOX 910, MARTIN, KY 41649-0910
(606) 285-6400
(606) 285-6619
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65904112
—
KY
Enumeration date
01/19/2007
Last updated
11/01/2007
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