Provider Demographics
NPI:1205025301
Name:OHIO COUNTY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:OHIO COUNTY HOSPITAL CORPORATION
Other - Org Name:OHIO COUNTY PAIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-504-1910
Mailing Address - Street 1:P O BOX 148
Mailing Address - Street 2:1520 NORTH MAIN STREET
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320
Mailing Address - Country:US
Mailing Address - Phone:270-274-7112
Mailing Address - Fax:270-274-7698
Practice Address - Street 1:1520 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8960
Practice Address - Country:US
Practice Address - Phone:270-274-7112
Practice Address - Fax:270-274-7698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO COUNTY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-15
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000537155OtherANTHEM
KY7100027630Medicaid
KY7100027630Medicaid