Provider Demographics
NPI:1033878962
Name:KNOX COUNTY GENERAL HEALTH DISTRICT
Entity Type:Organization
Organization Name:KNOX COUNTY GENERAL HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:KEYES
Authorized Official - Last Name:BELANGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-392-2200
Mailing Address - Street 1:11660 UPPER GILCHRIST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9084
Mailing Address - Country:US
Mailing Address - Phone:740-392-2200
Mailing Address - Fax:740-393-9612
Practice Address - Street 1:207 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2427
Practice Address - Country:US
Practice Address - Phone:740-392-1181
Practice Address - Fax:740-392-1180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNOX COUNTY GENERAL HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH216583Medicaid