Provider Demographics
NPI:1073504981
Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARRA COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-762-1273
Mailing Address - Street 1:803 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2432
Mailing Address - Country:US
Mailing Address - Phone:270-762-1100
Mailing Address - Fax:270-767-3657
Practice Address - Street 1:803 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2432
Practice Address - Country:US
Practice Address - Phone:270-762-1100
Practice Address - Fax:270-767-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100053282N00000X
KYP050533336I0012X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054618OtherKY ACCESS PROV #
KY27OtherACCORDIA
KY279005OtherHEALTHLINK PROVIDER #
KY000000072460OtherBC PRO-FEE PROVIDER #
KY031200999OtherU.S. DPT OF ENERGY PROV #
KY1069382OtherPASSPORT HEALTH PROV. #
KY9029OtherCARE CHOICE PROV #
KY5402535800Medicaid
KY000000054618OtherBC HOSPITAL #
KY000000054618OtherUNICARE PROVIDER #
KY01008549Medicaid
KY000000061955OtherBC LAB FEE PROVIDER #
KY163103600OtherU.S. DEPT OF LABOR PROV #
KY000000061955OtherBC LAB FEE PROVIDER #