1063409266 NPI number — GREEN RIVER DISTRICT HEALTH DEPT

Table of content: (NPI 1063409266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063409266 NPI number — GREEN RIVER DISTRICT HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN RIVER DISTRICT HEALTH DEPT
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:
6
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:
1063409266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-686-8123
Provider Business Mailing Address Fax Number:
270-683-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 BRECKENRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-686-8123
Provider Business Practice Location Address Fax Number:
270-683-1119
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FILLMAN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
270-686-7747

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  150007 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X , with the licence number: 150007 , 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)

  • Identifier: 3400251900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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