Provider Demographics
NPI:1740283894
Name:CALDWELL COUNTY HOSPITAL, INC
Entity type:Organization
Organization Name:CALDWELL COUNTY HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-365-0321
Mailing Address - Street 1:1310 US HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6106
Mailing Address - Country:US
Mailing Address - Phone:270-365-2011
Mailing Address - Fax:270-365-9433
Practice Address - Street 1:1310 US HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-6106
Practice Address - Country:US
Practice Address - Phone:270-365-2011
Practice Address - Fax:270-365-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150099251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054481OtherBC/BS SUPPLIER NUMBER
KY34001172Medicaid
KY42001172Medicaid
KY42001172Medicaid
KY=========009OtherCHAMPUS SUPPLIER NUMBER