1417009416 NPI number — T J SAMSON COMMUNITY HOSPITAL

Table of content: (NPI 1417009416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417009416 NPI number — T J SAMSON COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T J SAMSON COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
T J SAMSON HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417009416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645996
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45264-5996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-651-4444
Provider Business Mailing Address Fax Number:
270-651-4862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 N RACE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-651-4430
Provider Business Practice Location Address Fax Number:
270-651-4862
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORNBURY
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-651-4159

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  150061 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42005017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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