Provider Demographics
NPI:1316939689
Name:CLINTON COUNTY HOSPITAL, INC.
Entity type:Organization
Organization Name:CLINTON COUNTY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:D
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-387-3600
Mailing Address - Street 1:723 BURKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1654
Mailing Address - Country:US
Mailing Address - Phone:606-387-6421
Mailing Address - Fax:606-387-8550
Practice Address - Street 1:723 BURKESVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1654
Practice Address - Country:US
Practice Address - Phone:606-387-6421
Practice Address - Fax:606-387-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100078282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054951OtherBLUE CROSS BLUE SHIELD
KY61124OtherBLUEGRASS FAMILY
KY9388OtherTENNCARE
KY01002427Medicaid
KY500-00062OtherUNITED HEALTHCARE
KY61101OtherHUMANA
KY030644000OtherBLACK LUNG
KY=========OtherCHAMPUS
KY9388OtherTENNCARE
KY18U106Medicare Oscar/Certification