Basic Information
| Provider Information | |||||||||
| NPI: | 1790840056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHALL COUNTY HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 OLD SYMSONIA RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420255042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705274800 | ||||||||
| FaxNumber: | 2705274853 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 OLD SYMSONIA RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420255042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705274800 | ||||||||
| FaxNumber: | 2705274853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | FUQUA | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2705274800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 600078 | KY | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 000000054609 | 01 | KY | BLUE CROSS | OTHER | 12700241 | 05 | KY | MEDICAID |