MEDICARE: NICHOLAS COMMUNITY HOSPITAL, 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	282NC0060X	Critical Access Hospital

General Provider Information

NPI Number	:	1801056239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS COMMUNITY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	2323 CONCRETE RD
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-9721
Country	:	US
Telephone Number	:	859-289-7181
Fax Number	:	859-289-4323

Provider Business Practice Location Address
First Line	:	2323 CONCRETE RD
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-9721
Country	:	US
Telephone Number	:	859-289-7181
Fax Number	:	859-289-4323

Authorized Official
Title or Position	:	CEO
Name	:	MS. DORIS R ECTON
Credential	:
Telephone Number	:	859-289-7181

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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