| Organization Name: | MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES |
| NPI Number: | 1043501091 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARMEL JONES (COO/VP FINANCE) |
| Mailing Address: | 1406 W 5th St Ste 201 London |
| State: | KY US |
| Postal Code: | 407411688 |
| Phone Number: | 6063302377 |
| Fax Number: | 6063302369 |
| NPI Enumeration Date: | 04/26/2011 |
| NPI Last Update Date: | 04/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 700216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |