NPIMap

Organization Active NPI

Marshall County Hospital District

  • Medicare Defined Swing Bed Hospital Unit
  • Benton, KY
National Provider Identifier
1790840056
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
600078 Issued in KY
Legal business name
MARSHALL COUNTY HOSPITAL DISTRICT
Practice address
615 Old Symsonia Rd
Benton, KY 42025-5042
Phone
(270) 527-4800
Fax
(270) 527-4853
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Authorized official

Name
David Fuqua
Title
Administrator
Phone
(270) 527-4800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 600078 KY Primary

Addresses

Primary practice location

615 Old Symsonia Rd
Benton, KY 42025-5042

Mailing address

615 Old Symsonia Rd
Benton, KY 42025-5042
Phone (270) 527-4800

Other identifiers 2

IdentifierTypeStateIssuer
000000054609OtherKYBLUE CROSS
12700241MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071214000116 KY Part A Provider - Critical Access Hospital 3375581986 Practice locations: Benton, KY

Hospital certification: CCN 18Z327

Legal name
MARSHALL COUNTY HOSPITAL DISTRICT
Doing business as
MARSHALL COUNTY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Oct 31, 1974 in KY
Enrollment address
615 Old Symsonia Rd
Benton, KY 42025-5042

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

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
Tax ID family
Marshall County Hospital and Long Term Care Facility4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Janice Kelley Individual Corporate OfficerChief Financial Officer Oct 9, 1995
Steven Luther Individual Corporate OfficerChief Executive Officer Feb 28, 2026
W-2 Managing Employee Feb 28, 2026

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.

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1790840056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 OLD SYMSONIA RD",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420255042",
            "telephone_number": "270-527-4800",
            "fax_number": "270-527-4853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 OLD SYMSONIA RD",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420255042",
            "telephone_number": "270-527-4800",
            "fax_number": "270-527-4853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "FUQUA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "270-527-4800"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "KY",
            "license": "600078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000054609",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12700241",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, KY

Sources for this page

Verify at the official NPI Registry.