Provider Demographics
NPI:1871567362
Name:CASEY COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:CASEY COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUNGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-403-0732
Mailing Address - Street 1:187 WOLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3187
Mailing Address - Country:US
Mailing Address - Phone:606-787-6275
Mailing Address - Fax:606-787-8925
Practice Address - Street 1:187 WOLFORD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3187
Practice Address - Country:US
Practice Address - Phone:606-787-6275
Practice Address - Fax:606-787-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900075261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65909897Medicaid
KY18-3428Medicare Oscar/Certification
KY7811Medicare ID - Type UnspecifiedMEDICARE PART B