Provider Demographics
NPI:1386953966
Name:JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUNGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-932-4211
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-0220
Mailing Address - Country:US
Mailing Address - Phone:270-932-4211
Mailing Address - Fax:270-299-2041
Practice Address - Street 1:202-206 MILBY STREET
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1136
Practice Address - Country:US
Practice Address - Phone:270-932-4211
Practice Address - Fax:270-299-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600077291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01014232Medicaid
KY01014232Medicaid