Provider Demographics
NPI:1568528594
Name:MARSHALL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MARSHALL COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-527-4800
Mailing Address - Street 1:615 OLD SYMSONIA RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5042
Mailing Address - Country:US
Mailing Address - Phone:270-527-4800
Mailing Address - Fax:270-527-4853
Practice Address - Street 1:615 OLD SYMSONIA RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5042
Practice Address - Country:US
Practice Address - Phone:270-527-4800
Practice Address - Fax:270-527-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600078282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01015338Medicaid
KY000000054610OtherBLUE CROSS
362914OtherFEDERAL BLACK LUNG
KY0221Medicare PIN
KY3322145Medicare PIN
362914OtherFEDERAL BLACK LUNG
KY181327Medicare Oscar/Certification
KY000000054610OtherBLUE CROSS
KY3322164Medicare PIN
KY3322163Medicare PIN