Provider Demographics
NPI:1699812438
Name:POWELL COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:POWELL COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-663-0204
Mailing Address - Street 1:376 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2169
Mailing Address - Country:US
Mailing Address - Phone:606-663-0204
Mailing Address - Fax:606-663-9790
Practice Address - Street 1:376 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2169
Practice Address - Country:US
Practice Address - Phone:606-663-0204
Practice Address - Fax:606-663-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20099016Medicaid
KY15000599Medicaid
KYW79242Medicare UPIN
KYW79242Medicare UPIN