Provider Demographics
NPI:1013954437
Name:RUSSELL COUNTY HOSPITAL
Entity Type:Organization
Organization Name:RUSSELL COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-866-4753
Mailing Address - Street 1:153 DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4579
Mailing Address - Country:US
Mailing Address - Phone:270-866-4753
Mailing Address - Fax:270-866-7148
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:270-866-4753
Practice Address - Fax:270-866-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100529282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01000371Medicaid
KY181330Medicare ID - Type UnspecifiedAFTER 122505