Basic Information
| Provider Information | |||||||||
| NPI: | 1407829567 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASEY COUNTY HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 WOLFORD AVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425393187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067876275 | ||||||||
| FaxNumber: | 6067870251 | ||||||||
| Practice Location | |||||||||
| Address1: | 187 WOLFORD AVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425393187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067876275 | ||||||||
| FaxNumber: | 6067870251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | TUNGATE | ||||||||
| AuthorizedOfficialFirstName: | REX | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO ADMINITSTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6067876275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 282NC0060X | 600060 | KY | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 65941304 | 05 | KY | MEDICAID | 01000280 | 05 | KY | MEDICAID |