Provider Demographics
NPI:1437109923
Name:HOSPITAL OF FULTON INC
Entity Type:Organization
Organization Name:HOSPITAL OF FULTON INC
Other - Org Name:CLINTON-HICKMAN COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:351 MOSS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:KY
Mailing Address - Zip Code:42031-1321
Mailing Address - Country:US
Mailing Address - Phone:270-653-6277
Mailing Address - Fax:
Practice Address - Street 1:351 MOSS DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:KY
Practice Address - Zip Code:42031-1321
Practice Address - Country:US
Practice Address - Phone:270-653-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL OF FULTON INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY295172OtherBCBS
KY35000199Medicaid
KY9622Medicare PIN
KY183987Medicare Oscar/Certification