NPIMap

Organization Active NPI

Caldwell County Hospital Inc

Doing business as Caldwell Medical Associates

  • Rural Health Clinic/Center
  • Fredonia, KY
National Provider Identifier
1265076947
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CALDWELL COUNTY HOSPITAL INC
Doing business as
Caldwell Medical Associates
Practice address
700 Cassidy Ave
Fredonia, KY 42411-9207
Phone
(270) 545-3386
Fax
(270) 365-4152
NPI assigned
Nov 5, 2019
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Teresa L. Carpenter
Title
Director
Phone
(270) 365-0238

Specialties & licenses 1

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

Addresses

Primary practice location

700 Cassidy Ave
Fredonia, KY 42411-9207

Mailing address

PO Box 410
Princeton, KY 42445-0410
Phone (270) 545-3386

Other names 1

  • Caldwell Medical Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191226001728 KY Part A Provider - Rural Health Clinic 0749275014 Practice locations: Fredonia, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265076947. Details of each certification follow.

Rural health clinic certification: CCN 188529

Legal name
CALDWELL COUNTY HOSPITAL, INC
Doing business as
CALDWELL MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 2020
Last certification
Jun 4, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 2, 1947 in KY
Enrollment address
700 Cassidy Ave
Fredonia, KY 42411-9207
Related CCNs
181322

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

Other NPIs with the same Medicare PAC ID 6

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
18D0684309Caldwell Medical Associates700 Cassidy Lane, Fredonia, KY 42411Certificate of waiverDec 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mike Littlejohn7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

403 W Fairview Ave
Eddyville, KY 42038
Phone (270) 388-5454

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
David Lee Oliver Individual Corporate DirectorBoard Member Dec 1, 2019
Nacy Elizabeth Butts Individual Corporate OfficerChief Financial Officer Dec 1, 2019
W-2 Managing EmployeeChief Financial Officer Dec 1, 2019
Charles Littlejohn Individual Corporate DirectorBoard Member Dec 1, 2019
Joseph Falder Individual Corporate OfficerVice Chairman Dec 1, 2019
Harold D Odegaard Individual Corporate OfficerChief Executive Officer Dec 1, 2019
W-2 Managing EmployeeChief Executive Officer Dec 1, 2019
Monte Nesmith Individual Corporate DirectorBoard Member Dec 1, 2019
Martiza C Stallins Individual Corporate DirectorBoard Member Dec 1, 2019
Ellen Dunning Individual Corporate DirectorBoard Member Dec 1, 2019
Patricia Lander Individual Corporate DirectorBoard Member Dec 1, 2019
John Bugg Individual Corporate DirectorBoard Member Dec 1, 2019
Joseph Gray Individual Corporate DirectorChairman Dec 1, 2019
Steve Woodward Individual Corporate DirectorBoard Member Dec 1, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1265076947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424450410",
            "telephone_number": "270-545-3386",
            "fax_number": "270-365-4152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CASSIDY AVE",
            "city": "FREDONIA",
            "state": "KY",
            "postal_code": "424119207",
            "telephone_number": "270-545-3386",
            "fax_number": "270-365-4152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALDWELL COUNTY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-05",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "270-365-0238"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caldwell Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredonia, KY

Sources for this page

Verify at the official NPI Registry.