Healthcare Provider Details

I. General information

NPI: 1265481022
Provider Name (Legal Business Name): CRITTENDEN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E MAIN ST
SALEM KY
42078
US

IV. Provider business mailing address

117 E MAIN ST
SALEM KY
42078-9998
US

V. Phone/Fax

Practice location:
  • Phone: 270-988-3839
  • Fax: 270-988-3832
Mailing address:
  • Phone: 270-988-3839
  • Fax: 270-988-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number900061
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900061
License Number StateKY

VIII. Authorized Official

Name: MISTY KAY MCKINNEY
Title or Position: CONTROLLER
Credential:
Phone: 270-965-1001