MEDICARE: ROCKCASTLE 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	252Y00000X	Early Intervention Provider Agency
2	251E00000X	Home Health Agency	150179	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150179	OTHER	KY	STATE ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000203172	OTHER	KY	BLUE CROSS BLUE SHIELD
4	42000083	OTHER	KY	WAIVER
5	45002045	OTHER	KY	EPSDT
6	C-76	OTHER	KY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588637425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKCASTLE COUNTY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	145 LEWIS ST
Second Line	:	P O BOX 1186
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2761
Country	:	US
Telephone Number	:	606-256-2195
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 LEWIS ST
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2761
Country	:	US
Telephone Number	:	606-256-2195
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. CHARLES BLACK
Credential	:
Telephone Number	:	606-256-2195

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	03/29/2010

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