1114059029 NPI number — GATEWAY DISTRICT HEALTH DEPARTMENT

Table of content: (NPI 1114059029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114059029 NPI number — GATEWAY DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY 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:
BATH COUNTY HEALTH CENTER
Provider Other Organization Name Type Code:
5
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:
1114059029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 555
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-674-6396
Provider Business Mailing Address Fax Number:
606-674-3071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 OBERLINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-674-2731
Provider Business Practice Location Address Fax Number:
606-674-9646
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BREWER
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
606-674-6396

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1023051208 . This is a "CINDY CRAGER, ARNP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1811246143 . This is a "JESSICA LYKINS, APRN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20006011 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255326104 . This is a "JUDY LEE, ARNP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1588668339 . This is a "DR. ESKEW" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1558561910 . This is a "SANDRA ELLINGTON, MS,RD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1376742932 . This is a "WENDY LYKINS, ARNP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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