Provider Demographics
NPI:1457431314
Name:MCCREARY COUNTY JUDGE
Entity type:Organization
Organization Name:MCCREARY COUNTY JUDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-376-5063
Mailing Address - Street 1:1 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653
Mailing Address - Country:US
Mailing Address - Phone:606-376-5063
Mailing Address - Fax:606-376-8772
Practice Address - Street 1:1 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653
Practice Address - Country:US
Practice Address - Phone:606-376-5063
Practice Address - Fax:606-376-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1312341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN109345Medicaid
KY55074066Medicaid
0769495OtherUNITED MINE WORKERS ASSOC
874360OtherBLACK LUNG
KY000000070057OtherBLUE CROSS BLUE SHIELD
KY000000070057OtherANTHEM
590014296OtherRAILROAD MEDICARE
KY8032401Medicare PIN