Provider Demographics
NPI:1588837223
Name:CASEY COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CASEY COUNTY HOSPITAL DISTRICT
Other - Org Name:CASEY COUNTY PRIMARY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUNGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-384-4753
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASEY COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6590989700Medicaid