Healthcare Provider Details

I. General information

NPI: 1407829567
Provider Name (Legal Business Name): CASEY COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 WOLFORD AVE
LIBERTY KY
42539-3187
US

IV. Provider business mailing address

187 WOLFORD AVE
LIBERTY KY
42539-3187
US

V. Phone/Fax

Practice location:
  • Phone: 606-787-6275
  • Fax: 606-787-0251
Mailing address:
  • Phone: 606-787-6275
  • Fax: 606-787-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number600060
License Number StateKY

VIII. Authorized Official

Name: REX A TUNGATE
Title or Position: CEO ADMINITSTRATOR
Credential:
Phone: 606-787-6275