1457568446 NPI number — KENTUCKY RIVER DISTRICT 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 1457568446 NPI number — KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY RIVER DISTRICT 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:
1457568446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
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:
625 BIG WILLARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUSY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41723-8754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-436-6807
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

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: 7100000460 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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