Basic Information
| Provider Information | |||||||||
| NPI: | 1013379528 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE MEDICAL CENTER AT CLINTON COUNTY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE MEDICAL CENTER AT ALBANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421028000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063876421 | ||||||||
| FaxNumber: | 6063878550 | ||||||||
| Practice Location | |||||||||
| Address1: | 723 BURKESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426021654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063876421 | ||||||||
| FaxNumber: | 6063878550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2016 | ||||||||
| LastUpdateDate: | 10/21/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SOWELL | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2707451500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 100078 | KY | N | Hospitals | General Acute Care Hospital | Rural | 275N00000X | 100078 | KY | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 000000995896 | 01 | KY | ANTHEM | OTHER | 7100415350 | 05 | KY | MEDICAID |