Provider Demographics
NPI:1679516025
Name:CRITTENDEN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CRITTENDEN COUNTY HOSPITAL
Other - Org Name:CRITTENDEN HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-965-1042
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-0386
Mailing Address - Country:US
Mailing Address - Phone:270-965-5281
Mailing Address - Fax:270-965-4852
Practice Address - Street 1:520 W GUM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1516
Practice Address - Country:US
Practice Address - Phone:270-965-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1621A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74900010Medicaid
KYCG9059OtherRAILROAD MEDICARE
KY74900010Medicaid