Provider Demographics
NPI:1154335925
Name:KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR IV
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSW
Authorized Official - Phone:606-439-2361
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:239 LOVERN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1727
Practice Address - Country:US
Practice Address - Phone:606-436-2196
Practice Address - Fax:606-439-1813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY RIVER DISTRICT HEALTH DEPT.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0596OtherGROUP NUMBER
KY15000672OtherHANDS MEDICAID
KY20097010Medicaid
KY0596OtherGROUP NUMBER
KY0059618Medicare PIN