Provider Demographics
NPI:1891761300
Name:JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
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 1:704 COLUMBIA HWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-1118
Mailing Address - Country:US
Mailing Address - Phone:270-932-5355
Mailing Address - Fax:270-932-5590
Practice Address - Street 1:704 COLUMBIA HWY
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1118
Practice Address - Country:US
Practice Address - Phone:270-932-5355
Practice Address - Fax:270-932-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900193261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100030700Medicaid
KY183454Medicare Oscar/Certification
KY00034Medicare PIN
KY1101901Medicare PIN