Healthcare Provider Details

I. General information

NPI: 1649454067
Provider Name (Legal Business Name): CASEY COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 WOLFORD AVE
LIBERTY KY
42539-3278
US

IV. Provider business mailing address

187 WOLFORD AVE
LIBERTY KY
42539-3278
US

V. Phone/Fax

Practice location:
  • Phone: 606-787-6275
  • Fax: 606-787-9717
Mailing address:
  • Phone: 606-787-6275
  • Fax: 606-787-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number31531
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28235
License Number StateKY

VIII. Authorized Official

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