1780641035 NPI number — CLAY COUNTY FISCAL COURT

Table of content: (NPI 1780641035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780641035 NPI number — CLAY COUNTY FISCAL COURT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY COUNTY FISCAL COURT
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:
1780641035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 RICHMOND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-598-8413
Provider Business Mailing Address Fax Number:
606-598-1875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-8413
Provider Business Practice Location Address Fax Number:
606-598-1875
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAGERS
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
606-598-8413

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1359 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 057235700 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1069742 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2434809000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 56003734 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000331660 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 55026017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2577377 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0717614 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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