Healthcare Provider Details

I. General information

NPI: 1396713079
Provider Name (Legal Business Name): HOSPITAL OF FULTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W CLAY ST
CLINTON KY
42031-1317
US

IV. Provider business mailing address

PO BOX 60985
SAINT LOUIS MO
63160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 270-653-6277
  • Fax: 270-653-4097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900016
License Number StateKY

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTH OFFICIAL/DIR BUSINESS OFFICE
Credential:
Phone: 615-465-7466