Provider Demographics
NPI:1518141043
Name:CASEY COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CASEY COUNTY HOSPITAL DISTRICT
Other - Org Name:CASEY COUNTY HOSPITAL SWING BED UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUNGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-787-6275
Mailing Address - Street 1:187 WOLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3278
Mailing Address - Country:US
Mailing Address - Phone:606-787-6275
Mailing Address - Fax:606-787-0251
Practice Address - Street 1:187 WOLFORD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3278
Practice Address - Country:US
Practice Address - Phone:606-787-6275
Practice Address - Fax:606-787-0251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASEY COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600060275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100159170Medicaid