Provider Demographics
NPI:1760475925
Name:T J SAMSON COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:T J SAMSON COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-4159
Mailing Address - Street 1:PO BOX 645996
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5996
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:270-651-4892
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3454
Practice Address - Country:US
Practice Address - Phone:270-651-4444
Practice Address - Fax:270-651-4892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:T J REGIONAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100761314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054533OtherANTHEM
KY185387Medicare PIN