Provider Demographics
NPI:1679720114
Name:CASEY COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CASEY COUNTY HOSPITAL DISTRICT
Other - Org Name:CASEY COUNTY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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:CEO
Authorized Official - Phone:606-787-6275
Mailing Address - Street 1:199 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3064
Mailing Address - Country:US
Mailing Address - Phone:606-787-5044
Mailing Address - Fax:606-787-0251
Practice Address - Street 1:199 ADAMS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3064
Practice Address - Country:US
Practice Address - Phone:606-787-5044
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:2008-08-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100070150Medicaid
KY183466Medicare Oscar/Certification