NPIMap

Organization Active NPI

Marshall County Hospital District

Doing business as Marshall Co Surgical & Medical Group

  • Family Medicine Physician
  • Benton, KY
National Provider Identifier
1689778250
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TP638 Issued in KY
Legal business name
MARSHALL COUNTY HOSPITAL DISTRICT
Doing business as
Marshall Co Surgical & Medical Group
Practice address
619 Old Symsonia Rd
Benton, KY 42025-5094
Phone
(270) 527-2411
Fax
(270) 527-8734
NPI assigned
Sep 12, 2006
Last updated
Apr 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Mrs. Janice Kelley
Title
Cfo
Phone
(270) 527-4852

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA540 KY
Family Nurse Practitioner 363LF0000X 2422P KY
Certified Registered Nurse Anesthetist 367500000X 1026012 KY
Certified Registered Nurse Anesthetist 367500000X 1559A KY
Certified Registered Nurse Anesthetist 367500000X 1027758 KY
Certified Registered Nurse Anesthetist 367500000X 034466 KY
Family Medicine Physician 207Q00000X 24262 KY
Family Medicine Physician 207Q00000X TP638 KY Primary
Internal Medicine Physician 207R00000X 17956 KY
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 21862 KY
Orthopaedic Surgery Physician 207X00000X 24325 KY

Addresses

Primary practice location

619 Old Symsonia Rd
Benton, KY 42025-5094

Mailing address

619 Old Symsonia Rd
Benton, KY 42025-5094
Phone (270) 527-2411

Other identifiers 7

IdentifierTypeStateIssuer
000000057043OtherKYBLUE CROSS AND BLUE SHIEL
65912362MedicaidKY
000000054610OtherKYBLUE CROSS
DF7240OtherKYRR MEDICARE
78905304MedicaidKY
01015338MedicaidKY
110104797OtherRR MEDICARE

Other names 1

  • Marshall Co Surgical & Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050422000645 KY Part B Supplier - Clinic/Group Practice 3375581986 Receives reassigned benefits from 26 practitioners
Practice locations: Benton, KY

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Locations

619 Old Symsonia Rd
Benton, KY 42025
Phone (270) 527-0880

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marshall County Hospital Home HealthBenton, KY, CCN 187161 Home health agency 5% Or Greater Direct Ownership Interest (25%) Jan 1, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • LHCG Xxiii, LLC

    dba Marshall County Hospital Home Health

    • Home Health Agency
    • Benton, KY
    • NPI 1376845834

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1689778250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 OLD SYMSONIA RD",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420255094",
            "telephone_number": "270-527-2411",
            "fax_number": "270-527-8734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 OLD SYMSONIA RD",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420255094",
            "telephone_number": "270-527-2411",
            "fax_number": "270-527-8734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "270-527-4852",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA540",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "2422P",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "1026012",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "1559A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "1027758",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "034466",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "24262",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "TP638",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "17956",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "KY",
            "license": "21862",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "KY",
            "license": "24325",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "000000057043",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65912362",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000054610",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DF7240",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78905304",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01015338",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110104797",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marshall Co Surgical & Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, KY

Sources for this page

Verify at the official NPI Registry.