Organization
ISLAND MEDICAL HENDERSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHAELAMY CHARLEY ESQ (CHIEF LEGAL OFFICER)
(240) 686-2300
Entity
Organization
Contact information
Practice address
1305 N ELM ST, HENDERSON, KY 42420-2783
(406) 862-3002
Mailing address
12420 MILESTONE CENTER DR STE 200, GERMANTOWN, MD 20876-7111
(240) 686-2300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/20/2017
Last updated
06/03/2020
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