Provider Demographics
NPI:1427201177
Name:PACER MANAGEMENT OF KENTUCKY LLC
Entity Type:Organization
Organization Name:PACER MANAGEMENT OF KENTUCKY LLC
Other - Org Name:KNOX COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-546-4175
Mailing Address - Street 1:80 HOSPITAL DR
Mailing Address - Street 2:PO BOX 10
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:606-545-4863
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:606-545-4863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACER HEALTH MANAGEMENT CORPORATION OF KENTUCKY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100024720Medicaid
KY01000348Medicaid
KY7100024720Medicaid