Provider Demographics
NPI: | 1407939515 |
---|---|
Name: | KNOX HOSPITAL CORPORATION |
Entity Type: | Organization |
Organization Name: | KNOX HOSPITAL CORPORATION |
Other - Org Name: | KNOX COUNTY HOSPITAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | AMANDA |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | ELLIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 606-545-5543 |
Mailing Address - Street 1: | 80 HOSPITAL DRIVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BARBOURVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40906-7363 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-546-4175 |
Mailing Address - Fax: | 606-545-5511 |
Practice Address - Street 1: | 80 HOSPITAL DR |
Practice Address - Street 2: | |
Practice Address - City: | BARBOURVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40906-7363 |
Practice Address - Country: | US |
Practice Address - Phone: | 606-546-4175 |
Practice Address - Fax: | 606-545-5511 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | KNOX HOSPITAL CORPORATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-10-23 |
Last Update Date: | 2012-10-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207L00000X, 207PE0004X, 207Q00000X, 207R00000X, 207RC0000X, 207RN0300X, 2085R0202X, 208M00000X, 363L00000X, 367500000X | ||
KY | 19588 | 207VG0400X |
KY | 600080 | 282NC0060X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207PE0004X | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 01000348 | Medicaid | |
KY | 01000348 | Medicaid |