1760955975 NPI number — KNOX COUNTY GENERAL HEALTH DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760955975 NPI number — KNOX COUNTY GENERAL HEALTH DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNOX COUNTY GENERAL HEALTH DISTRICT
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:
DANVILLE COMMUNITY HEALTH CENTER
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:
1760955975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11660 UPPER GILCHRIST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43050-9084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-392-2200
Provider Business Mailing Address Fax Number:
740-392-9613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-392-2200
Provider Business Practice Location Address Fax Number:
740-392-9613
Provider Enumeration Date:
01/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
ZACH
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH COMMISSIONER
Authorized Official Telephone Number:
740-392-2200

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0216583 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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