1922289065 NPI number — MARTIN COUNTY MIDDLE SCHOOL

Table of content: (NPI 1922289065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922289065 NPI number — MARTIN COUNTY MIDDLE SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN COUNTY MIDDLE SCHOOL
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:
Provider Other Organization Name Type Code:
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:
1922289065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 346
Provider Second Line Business Mailing Address:
136 ROCKCASTLE ROAD
Provider Business Mailing Address City Name:
INEZ
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41224-0346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-298-7752
Provider Business Mailing Address Fax Number:
606-298-0413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 MIDDLE SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41267-9711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-298-7752
Provider Business Practice Location Address Fax Number:
606-298-0413
Provider Enumeration Date:
11/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
606-298-7752

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: 20080016 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".