Basic Information
| Provider Information | |||||||||
| NPI: | 1851486708 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALDWELL COUNTY HOSPITAL INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | SWINGBED | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703650300 | ||||||||
| FaxNumber: | 2703650332 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703650300 | ||||||||
| FaxNumber: | 2703650332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SWANER | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2703650300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | KY | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 000000054480 | 01 | KY | BLUE CROSS | OTHER | 12700175 | 05 | KY | MEDICAID |