1073774881 NPI number — MONROE COUNTY 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 1073774881 NPI number — MONROE COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE COUNTY 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:
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:
1073774881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
452 EAST 4TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42167-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-487-6782
Provider Business Mailing Address Fax Number:
270-487-5457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAMALIEL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-457-2341
Provider Business Practice Location Address Fax Number:
270-487-5457
Provider Enumeration Date:
06/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
JILL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-487-6782

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: 7100048850 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com