1265481022 NPI number — CRITTENDEN COUNTY HOSPITAL

Table of content: (NPI 1265481022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265481022 NPI number — CRITTENDEN COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRITTENDEN COUNTY HOSPITAL
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:
BURKHART RURAL HEALTH CLINIC, CRITTENDEN HEALTH SYSTEMS
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:
1265481022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42078-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-988-3839
Provider Business Mailing Address Fax Number:
270-988-3832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-988-3839
Provider Business Practice Location Address Fax Number:
270-988-3832
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
MISTY
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
270-965-1001

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  900061 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X , with the licence number: 900061 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 35001981 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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