1326235276 NPI number — NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC

Table of content: (NPI 1326235276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326235276 NPI number — NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC
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:
UK NORTH FORK VALLEY COMMUNITY HEALTH CENTER PHARMACY
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:
1326235276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 MORTON BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-439-3557
Provider Business Mailing Address Fax Number:
606-436-6988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 MORTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-1559
Provider Business Practice Location Address Fax Number:
606-436-6988
Provider Enumeration Date:
09/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KINGERY
Authorized Official First Name:
JOE
Authorized Official Middle Name:
EAGLE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
606-439-1559

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  P07214 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X , with the licence number: P07214 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07214 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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