MEDICARE: CLINTON COUNTY HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NR1301X	Rural Acute Care Hospital	100078	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000054951	OTHER	KY	BLUE CROSS BLUE SHIELD
2	61124	OTHER	KY	BLUEGRASS FAMILY
3	9388	OTHER	KY	TENNCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	500-00062	OTHER	KY	UNITED HEALTHCARE
6	61101	OTHER	KY	HUMANA
7	030644000	OTHER	KY	BLACK LUNG

General Provider Information

NPI Number	:	1316939689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON COUNTY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	723 BURKESVILLE RD
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-1654
Country	:	US
Telephone Number	:	606-387-6421
Fax Number	:	606-387-8550

Provider Business Practice Location Address
First Line	:	723 BURKESVILLE RD
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-1654
Country	:	US
Telephone Number	:	606-387-6421
Fax Number	:	606-387-8550

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. J. D. MULLINS
Credential	:
Telephone Number	:	606-387-3600

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	06/04/2009

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Directions to “CLINTON COUNTY HOSPITAL, INC. ” Practice Location

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