1780666396 NPI number — LINCOLN TRAIL DISTRICT HEALTH DEPARTMENT

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 1780666396 NPI number — LINCOLN TRAIL DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN TRAIL 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:
HARDIN COUNTY 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:
1780666396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42702-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-769-1601
Provider Business Mailing Address Fax Number:
270-765-7274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 WESTPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-6196
Provider Business Practice Location Address Fax Number:
270-763-0397
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BEST
Authorized Official First Name:
SARA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-769-1601

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: 20047015 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1051435 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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