Healthcare Provider Details

I. General information

NPI: 1275685570
Provider Name (Legal Business Name): CAVERNA MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S DIXIE ST
HORSE CAVE KY
42749-1480
US

IV. Provider business mailing address

1501 S DIXIE ST
HORSE CAVE KY
42749-1480
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-2191
  • Fax: 270-786-1557
Mailing address:
  • Phone: 270-786-2191
  • Fax: 270-786-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number6500065
License Number StateKY

VIII. Authorized Official

Name: MR. ALAN ALEXANDER
Title or Position: CEO
Credential:
Phone: 270-786-2191