Healthcare Provider Details

I. General information

NPI: 1902874910
Provider Name (Legal Business Name): HOSPITAL OF FULTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOLIDAY LN SUITE 100
FULTON KY
42041-8468
US

IV. Provider business mailing address

PO BOX 60985
SAINT LOUIS MO
63160-0985
US

V. Phone/Fax

Practice location:
  • Phone: 270-472-1612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900017
License Number StateKY

VIII. Authorized Official

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