1689778250 NPI number — MARSHALL COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1689778250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689778250 NPI number — MARSHALL COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARSHALL COUNTY HOSPITAL DISTRICT
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:
MARSHALL CO SURGICAL & MEDICAL GROUP
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:
1689778250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 OLD SYMSONIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42025-5094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-527-2411
Provider Business Mailing Address Fax Number:
270-527-8734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 OLD SYMSONIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42025-5094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-527-2411
Provider Business Practice Location Address Fax Number:
270-527-8734
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
270-527-4852

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  TP638 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 24262 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 17956 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 21862 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 24325 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA540 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2422P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 034466 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 1026012 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 1027758 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 1559A , 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: 01015338 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054610 . This is a "BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 78905304 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000057043 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 110104797 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DF7240 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65912362 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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