1750397139 NPI number — KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT

Table of content: (NPI 1750397139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750397139 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:
1750397139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2018
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:
HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-593-5181
Provider Business Practice Location Address Fax Number:
606-593-7438
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKARD
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR IV
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: 15000961 . This is a "HANDS MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20095014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8372 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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