Provider Demographics
NPI:1386783868
Name:HARRISON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HARRISON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOADVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-235-3503
Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7498
Mailing Address - Country:US
Mailing Address - Phone:859-234-2300
Mailing Address - Fax:859-235-3699
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7498
Practice Address - Country:US
Practice Address - Phone:859-234-2300
Practice Address - Fax:859-235-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100167261Q00000X, 363A00000X, 363LF0000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000063307OtherANTHEM PROF SERV GRP ID
KY7100346050OtherNP GROUP MEDICAID
KY000000056932OtherANTHEM ER PROF GRP #
KY65930224Medicaid
KY7100346810OtherPA GROUP MEDICAID
KY0108OtherMEDICARE PTAN