Provider Demographics
NPI:1366742256
Name:HOSPICE OF SOUTHERN KENTUCKY INC
Entity type:Organization
Organization Name:HOSPICE OF SOUTHERN KENTUCKY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-746-9300
Mailing Address - Street 1:5872 SCOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7853
Mailing Address - Country:US
Mailing Address - Phone:270-746-9300
Mailing Address - Fax:270-782-3496
Practice Address - Street 1:5872 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7853
Practice Address - Country:US
Practice Address - Phone:270-782-3402
Practice Address - Fax:270-782-3496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF SOUTHERN KENTUCKY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101013060Medicaid