Provider Demographics
NPI:1972743839
Name:NORTHERN KENTUCKY INDEPENDENT DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:NORTHERN KENTUCKY INDEPENDENT DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT DIRECTOR OF HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:SREVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KATKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-341-4264
Mailing Address - Street 1:610 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3416
Mailing Address - Country:US
Mailing Address - Phone:859-341-4264
Mailing Address - Fax:859-578-3689
Practice Address - Street 1:8300 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9286
Practice Address - Country:US
Practice Address - Phone:859-282-3240
Practice Address - Fax:859-578-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare