1255645040 NPI number — ROCKCASTLE COUNTY HOSPITAL, INC.

Table of content: (NPI 1255645040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255645040 NPI number — ROCKCASTLE COUNTY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKCASTLE COUNTY HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROCKCASTLE FAMILY WELLNESS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255645040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 NEWCOMB AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40456-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-256-4148
Provider Business Mailing Address Fax Number:
606-256-7410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 NEWCOMB AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40456-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-256-4148
Provider Business Practice Location Address Fax Number:
606-256-7410
Provider Enumeration Date:
08/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BULLOCK
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
606-256-7761

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 100374 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 900239 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K017200 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".




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