Basic Information
| Provider Information | |||||||||
| NPI: | 1346247962 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JACKSON HOSPITAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KENTUCKY RIVER MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 JETTS DRIVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 413399622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066666000 | ||||||||
| FaxNumber: | 6066666102 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 JETT DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 413399622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066666000 | ||||||||
| FaxNumber: | 6066666102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2005 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP FINANCE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6152213840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 100620 | KY | Y | Hospitals | General Acute Care Hospital |
No ID Information.