NPIMap

Organization Active NPI

Ephraim McDowell Health Resource, Inc.

Doing business as Fort Logan Walk-in & Primary Care

  • Family Medicine Physician
  • Stanford, KY
National Provider Identifier
1386799757
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
900145 Issued in KY
Legal business name
EPHRAIM MCDOWELL HEALTH RESOURCE, INC.
Doing business as
Fort Logan Walk-in & Primary Care
Practice address
110 Metker TRL
Stanford, KY 40484-1065
Phone
(606) 365-3360
NPI assigned
Jan 24, 2007
Last updated
Dec 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Kinman
Title
Cfo
Phone
(859) 239-2424

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 900145 KY Primary

Addresses

Primary practice location

110 Metker TRL
Stanford, KY 40484-1065

Mailing address

PO Box 990
Danville, KY 40423-0990
Phone (859) 239-2379

Other names 1

  • Fort Logan Walk-in & Primary Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000776 KY Part B Supplier - Clinic/Group Practice 7517876956 Receives reassigned benefits from 259 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stanford, KY; Springfield, KY; Somerset, KY; Liberty, KY; Lancaster, KY; Harrodsburg, KY; Danville, KY

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

105 Ponder Ct
Ste 104
Danville, KY 40422
Phone (859) 236-4216

1107 Ben Ali Dr
Danville, KY 40422
Phone (859) 936-7230

1541 Lebanon Rd
Ste 2
Danville, KY 40422
Phone (859) 239-4500

190 Daniel Dr
Danville, KY 40422

222 S 3rd St
Danville, KY 40422
Phone (859) 236-9670

230 W Main St
Ste 200
Danville, KY 40422

440 Whirlaway Dr
Danville, KY 40422
Phone (859) 936-0303

466A Linden Ave
Harrodsburg, KY 40330
Phone (859) 734-5173

470 Linden Ave
Harrodsburg, KY 40330
Phone (859) 733-5864

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2018 Change of OwnershipThis provider was the seller Fort Logan Walk-in & Primary CareCCN 188516, KY, NPI 1205328895

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1386799757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 990",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404230990",
            "telephone_number": "859-239-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 METKER TRL",
            "city": "STANFORD",
            "state": "KY",
            "postal_code": "404841065",
            "telephone_number": "606-365-3360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPHRAIM MCDOWELL HEALTH RESOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "KINMAN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "859-239-2424"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "900145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Logan Walk-in & Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stanford, KY

Sources for this page

Verify at the official NPI Registry.