Provider Demographics
NPI:1245261858
Name:T J SAMSON COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:T J SAMSON COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-4159
Mailing Address - Street 1:PO BOX 645996
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5996
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:270-651-4862
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3454
Practice Address - Country:US
Practice Address - Phone:270-651-4430
Practice Address - Fax:270-651-4862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:T J REGIONAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150061251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34001057Medicaid
KY00291OtherFIRST STEPS PROVIDER NUMB
KY000000054534OtherBLUE CROSS PROVIDER NUMBE
KY42005017Medicaid
KY000000054534OtherBLUE CROSS PROVIDER NUMBE
KY187062Medicare Oscar/Certification