Basic Information
| Provider Information | |||||||||
| NPI: | 1740271576 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MURRAY CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPRING CREEK HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 POPLAR ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621281 | ||||||||
| FaxNumber: | 2707673657 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707522900 | ||||||||
| FaxNumber: | 2707522990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | CARPENTER | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 2707621281 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 000000054619 | 05 | KY | MEDICAID | 1250101100 | 05 | KY | MEDICAID |