Provider Demographics
NPI:1548392764
Name:TRIGG COUNTY HOSPITAL, INC
Entity Type:Organization
Organization Name:TRIGG COUNTY HOSPITAL, INC
Other - Org Name:TRIGG COUNTY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-522-0898
Mailing Address - Street 1:PO BOX 1724
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-1724
Mailing Address - Country:US
Mailing Address - Phone:270-522-0898
Mailing Address - Fax:270-522-5636
Practice Address - Street 1:214 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9153
Practice Address - Country:US
Practice Address - Phone:270-522-0898
Practice Address - Fax:270-522-5636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIGG COUNTY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35000447Medicaid
KY000000056982OtherANTHEM BC/BS
KY56982OtherANTHEM BCBS
KY000000056982OtherANTHEM BC/BS