Healthcare Provider Details

I. General information

NPI: 1467520650
Provider Name (Legal Business Name): CLINTON AND HICKMAN COUNTY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 S WASHINGTON ST
CLINTON KY
42031-1324
US

IV. Provider business mailing address

366 S WASHINGTON ST
CLINTON KY
42031-1324
US

V. Phone/Fax

Practice location:
  • Phone: 270-653-2461
  • Fax: 270-653-4162
Mailing address:
  • Phone: 270-653-2461
  • Fax: 270-653-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100180
License Number StateKY

VIII. Authorized Official

Name: MR. WILLIAM B. LITTLE
Title or Position: ADMINISTRAOT
Credential: ADMINISTRATOR
Phone: 270-653-2461