1114937208 NPI number — CUMBERLAND COUNTY HOSPITAL ASSOCIATION INC

Table of content: (NPI 1114937208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114937208 NPI number — CUMBERLAND COUNTY HOSPITAL ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND COUNTY HOSPITAL ASSOCIATION 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:
B.F. TAYLOR MEDICAL ARTS CLINIC
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:
1114937208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURKESVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42717-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-864-2511
Provider Business Mailing Address Fax Number:
270-864-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299A GLASGOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURKESVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-864-2555
Provider Business Practice Location Address Fax Number:
270-864-3777
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEIKIRK
Authorized Official First Name:
RICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
270-864-2511

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  900136 , 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: 000000243241 . This is a "BCBS EKKLECTONIC BILLING" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 35001304 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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