Basic Information
| Provider Information | |||||||||
| NPI: | 1720251325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOX COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 COSHOCTON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430501440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403939000 | ||||||||
| FaxNumber: | 7403993738 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 VERNEDALE DRIVE | ||||||||
| Address2: | STE B | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403993748 | ||||||||
| FaxNumber: | 7403993738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7403582109 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KNOX COUNTY GENERAL HEALTH DISTRICT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 251E00000X | OH | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0047292 | 05 | OH | MEDICAID |