1700102852 NPI number — BARREN RIVER DISTRICT HEALTH DEPARTMENT

Table of content: (NPI 1700102852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700102852 NPI number — BARREN RIVER DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARREN RIVER 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:
BARREN RIVER DENTAL CLINIC
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:
1700102852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42102-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-781-8039
Provider Business Mailing Address Fax Number:
270-796-8946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-781-8039
Provider Business Practice Location Address Fax Number:
270-796-8946
Provider Enumeration Date:
04/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHANEY
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DISTRICT DIRECTOR
Authorized Official Telephone Number:
270-781-8039

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 303114Z . This is a "CLINIC SITE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100120040 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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