1619949468 NPI number — NORTH CENTRAL DISTRICT HEALTH DEPT.

Table of content: (NPI 1619949468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619949468 NPI number — NORTH CENTRAL DISTRICT HEALTH DEPT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL 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:
TRIMBLE COUNTY HEALTH DEPT.
Provider Other Organization Name Type Code:
3
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:
1619949468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 HENRY CLAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBYVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-633-1243
Provider Business Mailing Address Fax Number:
502-633-7658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 MILLER LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-255-7701
Provider Business Practice Location Address Fax Number:
502-255-3760
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR-STUMP
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
502-633-1243

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: 1051433 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15001027 . This is a "HANDS-MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: FLU0295 . This is a "MEDICARE-FLU" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20112017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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