Provider Demographics
NPI:1760659205
Name:KENTUCKIANA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:KENTUCKIANA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-396-1500
Mailing Address - Street 1:4601 MEDICAL PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-9204
Mailing Address - Country:US
Mailing Address - Phone:812-284-6100
Mailing Address - Fax:812-284-6151
Practice Address - Street 1:4601 MEDICAL PLAZA WAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-9204
Practice Address - Country:US
Practice Address - Phone:812-284-6100
Practice Address - Fax:812-284-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150176Medicare Oscar/Certification