1093791915 NPI number — MARTIN 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 1093791915 NPI number — MARTIN COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN 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:
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:
1093791915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2012
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:
136 ROCKCASTLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INEZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41224
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:
12/22/2005

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".
  • Identifier: 600002502 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 15000748 . This is a "HANDS PROGRAM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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