Provider Demographics
NPI:1851376958
Name:CRITTENDEN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CRITTENDEN COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-965-1001
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
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:270-965-2770
Practice Address - Fax:270-965-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
610397301OtherFEDERAL BLACK LUNG PROGRAM
KY000000378864OtherANTHEM BLUE CROSS
163030800OtherUS DEPARTMENT OF LABOR
KY55028021Medicaid
KY56003817Medicaid
610397301OtherFEDERAL BLACK LUNG PROGRAM
KY55028021Medicaid