1477609865 NPI number — T J SAMSON COMMUNITY HOSPITAL

Table of content: (NPI 1477609865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477609865 NPI number — T J SAMSON COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T J SAMSON COMMUNITY 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:
Provider Other Organization Name Type Code:
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:
1477609865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645996
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45264-5996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-651-4444
Provider Business Mailing Address Fax Number:
270-651-4892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 N L ROGERS WELLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-651-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORNBURY
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
270-651-4159

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100746780 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100747840 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054533 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100261530 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100275010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100275030 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100732310 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100033180 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100261550 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100458590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100584480 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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