Basic Information
| Provider Information | |||||||||
| NPI: | 1780688333 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALDWELL COUNTY HOSPITAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 410 | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424450410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703650300 | ||||||||
| FaxNumber: | 2703650332 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424452301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703650300 | ||||||||
| FaxNumber: | 2703650332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | LOVELL | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2703650300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 282NC0060X | 600072 | KY | N | Hospitals | General Acute Care Hospital | Critical Access | 2083X0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000054479 | 01 | KY | BLUE CROSS | OTHER | 01006931 | 05 | KY | MEDICAID | 000000054480 | 01 | KY | BLUE CROSS SWINGBED | OTHER |