Provider Demographics
NPI:1487706578
Name:TRIGG COUNTY HOSPITAL INC.
Entity type:Organization
Organization Name:TRIGG COUNTY HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-522-3215
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-0312
Mailing Address - Country:US
Mailing Address - Phone:270-522-2548
Mailing Address - Fax:270-522-1871
Practice Address - Street 1:252 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9153
Practice Address - Country:US
Practice Address - Phone:270-522-2548
Practice Address - Fax:270-522-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150167251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000119131OtherPROVIDER NUMBER
KY34011114Medicaid
KY34011114Medicaid