Provider Demographics
NPI:1467520650
Name:CLINTON AND HICKMAN COUNTY HOSPITAL, INC.
Entity Type:Organization
Organization Name:CLINTON AND HICKMAN COUNTY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAOT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:270-653-2461
Mailing Address - Street 1:366 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:KY
Mailing Address - Zip Code:42031-1324
Mailing Address - Country:US
Mailing Address - Phone:270-653-2461
Mailing Address - Fax:270-653-4162
Practice Address - Street 1:366 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:KY
Practice Address - Zip Code:42031-1324
Practice Address - Country:US
Practice Address - Phone:270-653-2461
Practice Address - Fax:270-653-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100180314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502464Medicaid
KY185326Medicare ID - Type UnspecifiedPROVIDER NUMBER