Provider Demographics
NPI:1245209790
Name:CRITTENDEN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CRITTENDEN COUNTY HOSPITAL
Other - Org Name:CRITTENDEN HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-965-1001
Mailing Address - Street 1:520 W GUM ST
Mailing Address - Street 2:P.O. BOX 386
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-1516
Mailing Address - Country:US
Mailing Address - Phone:270-965-1042
Mailing Address - Fax:270-965-1061
Practice Address - Street 1:520 W GUM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064
Practice Address - Country:US
Practice Address - Phone:270-965-1042
Practice Address - Fax:270-965-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100080282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3400128900Medicaid
KY101623700Medicaid
KY18-7301Medicare ID - Type UnspecifiedMARION HOME HEALTH
KY18-0095Medicare Oscar/Certification
KY18-U095Medicare Oscar/Certification