Provider Demographics
NPI:1528102472
Name:LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-678-4761
Mailing Address - Street 1:500 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1916
Mailing Address - Country:US
Mailing Address - Phone:606-678-4761
Mailing Address - Fax:606-676-9671
Practice Address - Street 1:801 WESTLAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1162
Practice Address - Country:US
Practice Address - Phone:270-384-2286
Practice Address - Fax:270-384-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0300302OtherMEDICARE PROVIDER
KY1073590436OtherNPI RENDERING PROVIDER
KY1316135783OtherNPI RENDERING PROVIDER
KY1760469134OtherNPI RENDERING PROVIDER
KY15001308OtherHANDS MEDICAID
KY1568449445OtherNPI RENDERING PROVIDER
KY000000047568OtherBC/BS PROVIDER #
KY1770560716OtherNPI RENDERING PROVIDER
KY20001012Medicaid
KY1427035872OtherNPI RENDERING PROVIDER
KY1629055082OtherNPI RENDERING PROVIDER
KY1265410393OtherNPI RENDERING PROVIDER
KY1437271244OtherNPI RENDERING PROVIDER
KY50003866OtherPASSPORT MEDICAID
KY1780687798OtherNPI RENDERING PROVIDER
KY600000712OtherRR MEDICARE
KY1770560716OtherNPI RENDERING PROVIDER