Provider Demographics
NPI:1437152923
Name:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Entity Type:Organization
Organization Name:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Other - Org Name:TWIN LAKES EMERGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-259-9400
Mailing Address - Street 1:910 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1418
Mailing Address - Country:US
Mailing Address - Phone:270-259-9400
Mailing Address - Fax:
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1418
Practice Address - Country:US
Practice Address - Phone:270-259-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYSON COUNTY HOSPITAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY24428030000OtherPASSPORT ADVANTAGE
KY000000057018OtherANTHEM
KY50001188OtherPASSPORT
KY65930950Medicaid
KY0178Medicare PIN