Healthcare Provider Details

I. General information

NPI: 1922870583
Provider Name (Legal Business Name): JELLICO REGIONAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1604
US

IV. Provider business mailing address

10996 FOUR SEASONS PL STE 100C
CROWN POINT IN
46307-7762
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-5052
  • Fax:
Mailing address:
  • Phone: 219-228-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRNJOT SINGH
Title or Position: PRESIDENT
Credential: MD
Phone: 219-228-4355