Provider Demographics
NPI:1720251325
Name:KNOX COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:KNOX COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-358-2109
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-399-3738
Practice Address - Street 1:307 VERNEDALE DRIVE
Practice Address - Street 2:STE B
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-399-3748
Practice Address - Fax:740-399-3738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNOX COUNTY GENERAL HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0047292Medicaid
367079Medicare Oscar/Certification