NPIMap

Organization Active NPI

Russell County Hospital

  • Rural Health Clinic/Center
  • Russell Springs, KY
National Provider Identifier
1073936902
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RUSSELL COUNTY HOSPITAL
Practice address
124 Dowell Rd
Russell Springs, KY 42642-4278
Phone
(270) 866-4141
NPI assigned
Jan 29, 2014
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nequila Norris
Title
Director of Finance
Phone
(270) 858-6936

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

124 Dowell Rd
Russell Springs, KY 42642-4278

Mailing address

153 Dowell Rd
Russell Springs, KY 42642-4579
Phone (270) 866-4141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140429001357 KY Part A Provider - Rural Health Clinic 6204887243 Practice locations: Russell Springs, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073936902. Details of each certification follow.

Rural health clinic certification: CCN 183488

Legal name
RUSSELL COUNTY HOSPITAL
Doing business as
FAMILY PRACTICE ASSOCIATES OF RUSSELL COUNTY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 18, 2014
Last certification
Aug 18, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1981 in KY
Enrollment address
124 Dowell Rd
Russell Springs, KY 42642-4278
Related CCNs
181330

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0871179Family Practice Associates124 Dowell Road, Russell Springs, KY 42642Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Jamestown Healthcare Cent8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Steven Fletcher Individual Corporate DirectorBoard Member Feb 1, 2021
Scott Thompson Individual W-2 Managing EmployeeCeo May 1, 2022
Larry Helm Individual Corporate DirectorBoard Member Jan 1, 2023
Winfrey Bates Individual Corporate DirectorBoard Member Jul 1, 2019
Stuart Carman Individual Corporate DirectorBoard Member May 16, 2019
Nequila Norris Individual Corporate DirectorDirector of Finance Oct 25, 2023

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1073936902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 DOWELL RD",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426424579",
            "telephone_number": "270-866-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 DOWELL RD",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426424278",
            "telephone_number": "270-866-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-29",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "NEQUILA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "270-858-6936"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Russell Springs, KY

Sources for this page

Verify at the official NPI Registry.