Healthcare Provider Details

I. General information

NPI: 1538255948
Provider Name (Legal Business Name): RUSSELL COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 DOWELL RD
RUSSELL SPRINGS KY
42642-4579
US

IV. Provider business mailing address

PO BOX 1610
RUSSELL SPRINGS KY
42642-1610
US

V. Phone/Fax

Practice location:
  • Phone: 270-866-8867
  • Fax: 270-866-7148
Mailing address:
  • Phone: 270-866-8867
  • Fax: 270-866-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number600081
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number600081
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number600081
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number600081
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number600081
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NEQUILA NORRIS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 270-858-6936