Provider Demographics
NPI:1972531382
Name:CALDWELL COUNTY HOSPITAL, INC
Entity Type:Organization
Organization Name:CALDWELL COUNTY HOSPITAL, INC
Other - Org Name:LYON COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT REP
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-744-9600
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:403 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038
Practice Address - Country:US
Practice Address - Phone:270-388-5454
Practice Address - Fax:270-388-5452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65922767Medicaid
KY8346Medicare PIN