Healthcare Provider Details

I. General information

NPI: 1679516025
Provider Name (Legal Business Name): CRITTENDEN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
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

PO BOX 386
MARION KY
42064-0386
US

V. Phone/Fax

Practice location:
  • Phone: 270-965-5281
  • Fax:
Mailing address:
  • Phone: 270-965-5281
  • Fax: 270-965-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1621A
License Number StateKY

VIII. Authorized Official

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