Healthcare Provider Details

I. General information

NPI: 1003921032
Provider Name (Legal Business Name): MARSHALL COUNTY HOSP DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/23/2017
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

PO BOX 630
BENTON KY
42025-0630
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-4885
  • Fax: 270-527-4893
Mailing address:
  • Phone: 270-527-4800
  • Fax: 270-527-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberP05109
License Number StateKY

VIII. Authorized Official

Name: PHYLLIS BLACKWELL
Title or Position: CHIEF CLINICAL OFFICER
Credential: RPH
Phone: 270-527-4800