Basic Information
| Provider Information | |||||||||
| NPI: | 1316939689 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINTON COUNTY HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 BURKESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426021654 | ||||||||
| 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: | 08/22/2005 | ||||||||
| LastUpdateDate: | 06/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | MULLINS | ||||||||
| AuthorizedOfficialFirstName: | J. | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6063873600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 100078 | KY | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 000000054951 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | 61124 | 01 | KY | BLUEGRASS FAMILY | OTHER | 9388 | 01 | KY | TENNCARE | OTHER | 01002427 | 05 | KY | MEDICAID | 500-00062 | 01 | KY | UNITED HEALTHCARE | OTHER | 61101 | 01 | KY | HUMANA | OTHER | 030644000 | 01 | KY | BLACK LUNG | OTHER |