Provider Demographics
NPI:1982876173
Name:CASEY COUNTY PRIMARY CARE NURSING GROUP
Entity Type:Organization
Organization Name:CASEY COUNTY PRIMARY CARE NURSING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUNGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-384-4753
Mailing Address - Street 1:187 WOLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3278
Mailing Address - Country:US
Mailing Address - Phone:606-787-8348
Mailing Address - Fax:606-787-9717
Practice Address - Street 1:187 WOLFORD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3278
Practice Address - Country:US
Practice Address - Phone:606-787-8348
Practice Address - Fax:606-787-9717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASEY COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7890229300Medicaid