Provider Demographics
NPI:1487767828
Name:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Entity type:Organization
Organization Name:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-259-9400
Mailing Address - Street 1:910 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-2414
Mailing Address - Country:US
Mailing Address - Phone:270-259-9400
Mailing Address - Fax:270-259-9524
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2414
Practice Address - Country:US
Practice Address - Phone:270-259-9400
Practice Address - Fax:270-259-9524
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYSON COUNTY HOSPITAL FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01006733Medicaid
KY000000369642OtherANTHEM PROVIDER NUMBER
KY180070Medicare Oscar/Certification