Healthcare Provider Details

I. General information

NPI: 1841933496
Provider Name (Legal Business Name): CRITTENDEN COMMUNITY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21234 MARION RD
FREDONIA KY
42411-9250
US

IV. Provider business mailing address

520 W GUM ST
MARION KY
42064-1516
US

V. Phone/Fax

Practice location:
  • Phone: 270-545-2929
  • Fax:
Mailing address:
  • Phone: 270-965-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARREL MORRIS
Title or Position: COO
Credential:
Phone: 918-527-1234