Provider Demographics
| NPI: | 1477609865 |
|---|---|
| Name: | T J SAMSON COMMUNITY HOSPITAL |
| Entity Type: | Organization |
| Organization Name: | T J SAMSON COMMUNITY HOSPITAL |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NEIL |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | THORNBURY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 270-651-4159 |
| Mailing Address - Street 1: | PO BOX 645996 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45264-5996 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 270-651-4444 |
| Mailing Address - Fax: | 270-651-4892 |
| Practice Address - Street 1: | 310 N L ROGERS WELLS BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | GLASGOW |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 42141-1300 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 270-651-1111 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | T J REGIONAL HEALTH INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-01-26 |
| Last Update Date: | 2023-05-31 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207Q00000X, 207QH0002X, 207RC0000X, 207X00000X, 208D00000X, 363A00000X, 363AM0700X, 363L00000X, 363LA2200X, 363LC1500X, 363LF0000X, 363LS0200X, 364S00000X, 367500000X | ||
| KY | 261Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207QH0002X | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LC1500X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LS0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | School | Group - Multi-Specialty |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 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 | 7100746780 | Medicaid | |
| KY | 7100747840 | Medicaid | |
| KY | 000000054533 | Other | ANTHEM |
| KY | 7100261530 | Medicaid | |
| KY | 7100275010 | Medicaid | |
| KY | 7100275030 | Medicaid | |
| KY | 7100732310 | Medicaid | |
| KY | 7100033180 | Medicaid | |
| KY | 7100261550 | Medicaid | |
| KY | 7100458590 | Medicaid | |
| KY | 7100584480 | Medicaid | |
| KY | CJ6451 | Medicare PIN |
