Basic Information
Provider Information | |||||||||
NPI: | 1396263000 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ROCKCASTLE COUNTY HOSPITAL, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ROCKCASTLE REGIONAL QUICK CARE CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1770 LAKE CUMBERLAND RD | ||||||||
Address2: |   | ||||||||
City: | MOUNT VERNON | ||||||||
State: | KY | ||||||||
PostalCode: | 404568431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6062562195 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1770 LAKE CUMBERLAND RD | ||||||||
Address2: |   | ||||||||
City: | MOUNT VERNON | ||||||||
State: | KY | ||||||||
PostalCode: | 404568431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6062562195 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2017 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BASTIN | ||||||||
AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
AuthorizedOfficialMiddleName: | N. | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 6062562195 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 100960 | KY | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.