Healthcare Provider Details

I. General information

NPI: 1588930374
Provider Name (Legal Business Name): ROCKCASTLE COUNTY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 EAST MAIN STREET
MT. VERNON KY
40456
US

IV. Provider business mailing address

160 EAST MAIN STREET
MT. VERNON KY
40456
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-2961
  • Fax: 606-256-3562
Mailing address:
  • Phone: 606-256-2961
  • Fax: 606-256-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17377
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900253
License Number StateKY

VIII. Authorized Official

Name: CHARLES BLACK JR.
Title or Position: CFO
Credential:
Phone: 606-256-7745