Healthcare Provider Details

I. General information

NPI: 1790840056
Provider Name (Legal Business Name): MARSHALL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 OLD SYMSONIA RD
BENTON KY
42025-5042
US

IV. Provider business mailing address

615 OLD SYMSONIA RD
BENTON KY
42025-5042
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-4800
  • Fax: 270-527-4853
Mailing address:
  • Phone: 270-527-4800
  • Fax: 270-527-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number600078
License Number StateKY

VIII. Authorized Official

Name: DAVID FUQUA
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-527-4800