Provider Demographics
NPI:1215406434
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:42754-2414
Mailing Address - Country:US
Mailing Address - Phone:270-259-1656
Mailing Address - Fax:270-259-9536
Practice Address - Street 1:2902 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7102
Practice Address - Country:US
Practice Address - Phone:270-259-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYSON COUNTY HOSPITAL FOUNDATION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-16
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01006733Medicaid