Island Medical Henderson LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

ISLAND MEDICAL HENDERSON LLC

Practice address

1305 N Elm St
Henderson, KY 42420-2783

Phone

(406) 862-3002

NPI assigned

Jul 20, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Michaelamy Charley, ESQ

Title

Chief Legal Officer

Phone

(240) 686-2300

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1619490778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12420 MILESTONE CENTER DR STE 200",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208767111",
            "telephone_number": "240-686-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202783",
            "telephone_number": "406-862-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL HENDERSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "CHARLEY",
        "authorized_official_first_name": "MICHAELAMY",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "240-686-2300",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ESQ"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Husk
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• Jenny R Hutchinson, OTR/L
• Mikayla V Ilegomah
• Intervention Associates, PLLC
• J. R. Holdings, Inc
• James a Hohman MD, PSC
• Tamara James, LMFT
• Sarah Elizabeth Jankowski, OT
• Jason Samuel Chartered

• Emergency Medicine Physician in Henderson, KY
• Providers in Henderson, KY by specialty
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.