1073783395 NPI number — KENTUCKY RIVER DISTRICT HEALTH DEPT

Table of content: (NPI 1073783395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073783395 NPI number — KENTUCKY RIVER DISTRICT HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY 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:
1073783395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 GORMAN HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41701-2315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-439-2361
Provider Business Mailing Address Fax Number:
606-439-0870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B BALL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCROBERTS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-832-2323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DISTRICT DIRECTOR
Authorized Official Telephone Number:
606-439-2361

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: 7100031190 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com