=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154585289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2008
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202-206 MILBY STREET
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42743-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-932-4211
-----------------------------------------------------
Fax | 270-299-2041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202-206 MILBY STREET
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42743-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-932-4211
-----------------------------------------------------
Fax | 270-299-2041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR
-----------------------------------------------------
Name | MR. REX A TUNGATE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-384-4753
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 600077
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------