Healthcare Provider Details

I. General information

NPI: 1689778250
Provider Name (Legal Business Name): MARSHALL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 OLD SYMSONIA RD
BENTON KY
42025-5094
US

IV. Provider business mailing address

619 OLD SYMSONIA RD
BENTON KY
42025-5094
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-2411
  • Fax: 270-527-8734
Mailing address:
  • Phone: 270-527-2411
  • Fax: 270-527-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24262
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17956
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21862
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24325
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA540
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2422P
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number034466
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1026012
License Number StateKY
# 9
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1027758
License Number StateKY
# 10
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1559A
License Number StateKY
# 11
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTP638
License Number StateKY

VIII. Authorized Official

Name: MRS. JANICE KELLEY
Title or Position: CFO
Credential:
Phone: 270-527-4852