Provider Demographics
NPI:1114929494
Name:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Entity Type:Organization
Organization Name:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Other - Org Name:TWIN LAKES REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-259-1656
Mailing Address - Street 1:910 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1418
Mailing Address - Country:US
Mailing Address - Phone:270-259-9400
Mailing Address - Fax:
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1418
Practice Address - Country:US
Practice Address - Phone:270-259-9400
Practice Address - Fax:270-259-9524
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYSON COUNTY HOSPITAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X, 235Z00000X
KY100151282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4500270600Medicaid
KY01006733Medicaid
KY4588851800Medicaid
KY000000054565OtherANTHEM PROVIDER #
KY1048799OtherPASSPORT
KY2432221000OtherPASSPORT ADVANTAGE
KY180070Medicare Oscar/Certification