Provider Demographics
NPI:1033353636
Name:CALDWELL COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CALDWELL COUNTY HOSPITAL
Other - Org Name:CALDWELL COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-365-0300
Mailing Address - Street 1:101 HOSPITAL DR
Mailing Address - Street 2:PO BOX 410
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2301
Mailing Address - Country:US
Mailing Address - Phone:270-365-0300
Mailing Address - Fax:270-365-0413
Practice Address - Street 1:323 S JEFFERSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2100
Practice Address - Country:US
Practice Address - Phone:270-365-4505
Practice Address - Fax:270-365-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38226207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI21005Medicare UPIN
KY0941601Medicare PIN