1265576953 NPI number — LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT

Table of content: (NPI 1265576953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265576953 NPI number — LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WAYNE COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265576953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 BOURNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42501-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-678-4761
Provider Business Mailing Address Fax Number:
606-676-9671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 JIM HILL SERVICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42633-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-348-9340
Provider Business Practice Location Address Fax Number:
606-348-7464
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRABTREE
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
606-678-4761

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15001290 . This is a "HANDS MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1770560716 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1760469134 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20116018 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0300202 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1437271244 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1730326877 . This is a "RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50003866 . This is a "PASSPORT MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1427035872 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000047568 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1316135783 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1588825335 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1629055082 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1265410393 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1073590436 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1780687798 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 600000720 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1568449445 . This is a "NPI RENDERING PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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