Healthcare Provider Details

I. General information

NPI: 1033380613
Provider Name (Legal Business Name): CRITTENDEN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W GUM ST
MARION KY
42064-1516
US

IV. Provider business mailing address

520 W GUM ST
MARION KY
42064-1516
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA385
License Number StateKY

VIII. Authorized Official

Name: MR. THOMAS M HALES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 270-965-1042