Provider Demographics
NPI:1366992711
Name:PORSMOUTH HOSPITAL CORPORATION
Entity type:Organization
Organization Name:PORSMOUTH HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITLATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-408-4401
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0151
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:1901 ARGONNE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2827
Practice Address - Country:US
Practice Address - Phone:740-991-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH351600Medicare PIN