Organization
MORGAN-HAUGH PROFESSIONAL SERVICES CORPORATION
Active
Organization
MORGAN-HAUGH PROFESSIONAL SERVICES CORPORATION
Active
Other names
MORGAN-HAUGH MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN P BRAAKSMA (ADMINISTRATOR)
(270) 650-7138
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 247-8100
(270) 247-7780
Mailing address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 247-8100
(270) 247-7780
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
41115
KY
213E00000X
Podiatrist
00328
KY
231H00000X
Audiologist
917
KY
261QM1300X
Multi-Specialty Clinic/Center
Primary
27345
KY
363L00000X
Nurse Practitioner
2813P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0421
MEDICAID SITE
KY
05
—
3370270
—
TN
01
—
6590034200
MEDICAID GRP
KY
01
—
B08239004
MEDICARE DME SUBMITTER ID
KY
01
—
CE3275
RR GRP NO
KY
Enumeration date
10/23/2006
Last updated
12/10/2008
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