Provider Demographics
NPI:1932174968
Name:ADAIR COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ADAIR COUNTY HOSPITAL DISTRICT
Other - Org Name:WESTLAKE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-384-4753
Mailing Address - Street 1:810 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1010
Mailing Address - Country:US
Mailing Address - Phone:270-384-4764
Mailing Address - Fax:270-384-5826
Practice Address - Street 1:810 JAMESTOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1010
Practice Address - Country:US
Practice Address - Phone:270-384-4764
Practice Address - Fax:270-384-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7000034261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001049Medicaid
KY35001049Medicaid
KY2479Medicare ID - Type UnspecifiedMC PART B