MEDICARE: GRAYSON COUNTY HOSPITAL FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	275N00000X	Medicare Defined Swing Bed Hospital Unit	100151	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000054566	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1023010303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAYSON COUNTY HOSPITAL FOUNDATION INC

Provider Business Mailing Address
First Line	:	910 WALLACE AVE
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1418
Country	:	US
Telephone Number	:	270-259-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 WALLACE AVE
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1418
Country	:	US
Telephone Number	:	270-259-9400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN L MEREDITH
Credential	:
Telephone Number	:	270-259-9400

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/10/2007

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