Provider Demographics
NPI:1215198742
Name:CLINTON COUNTY HOSPITAL PHYSICIAN GROUP
Entity Type:Organization
Organization Name:CLINTON COUNTY HOSPITAL PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-387-3600
Mailing Address - Street 1:723 BURKESVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1654
Mailing Address - Country:US
Mailing Address - Phone:606-387-4473
Mailing Address - Fax:606-387-8550
Practice Address - Street 1:723 BURKESVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1654
Practice Address - Country:US
Practice Address - Phone:606-387-4473
Practice Address - Fax:606-387-8550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26114207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty