Provider Demographics
NPI:1265481022
Name:CRITTENDEN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CRITTENDEN COUNTY HOSPITAL
Other - Org Name:BURKHART RURAL HEALTH CLINIC, CRITTENDEN HEALTH SYSTEMS
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 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-9998
Mailing Address - Country:US
Mailing Address - Phone:270-988-3839
Mailing Address - Fax:270-988-3832
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078
Practice Address - Country:US
Practice Address - Phone:270-988-3839
Practice Address - Fax:270-988-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900061207QG0300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001981Medicaid
KY183456Medicare ID - Type Unspecified
KY35001981Medicaid