Provider Demographics
NPI:1043476161
Name:JOHNSON COUNTY HEALTH DEPT
Entity Type:Organization
Organization Name:JOHNSON COUNTY HEALTH DEPT
Other - Org Name:MEADE MEMORIAL ELEMENTARY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-789-2590
Mailing Address - Street 1:630 JAMES S TRIMBLE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINTVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1026
Mailing Address - Country:US
Mailing Address - Phone:606-789-2590
Mailing Address - Fax:606-789-8888
Practice Address - Street 1:8446 KY RT 40 EAST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:KY
Practice Address - Zip Code:41271
Practice Address - Country:US
Practice Address - Phone:606-789-2590
Practice Address - Fax:606-789-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20058012Medicaid
0746Medicare PIN