Provider Demographics
NPI:1902361165
Name:RUSSELL COUNTY HOSPITAL
Entity Type:Organization
Organization Name:RUSSELL COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-866-4753
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-1610
Mailing Address - Country:US
Mailing Address - Phone:270-866-4141
Mailing Address - Fax:
Practice Address - Street 1:153 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4579
Practice Address - Country:US
Practice Address - Phone:270-866-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSSELL COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942955Medicaid