1477702561 NPI number — ALLEN COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1477702561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477702561 NPI number — ALLEN COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEN 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:
1477702561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 N COURT ST
Provider Second Line Business Mailing Address:
P. O. BOX 129
Provider Business Mailing Address City Name:
SCOTTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42164-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-237-4423
Provider Business Mailing Address Fax Number:
270-237-4777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 BOWLING GREEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164-9647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-622-4119
Provider Business Practice Location Address Fax Number:
270-622-5882
Provider Enumeration Date:
09/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-237-4423

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: 7100067230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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