Provider Demographics
NPI:1073061644
Name:NORTH CENTRAL DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:NORTH CENTRAL DISTRICT HEALTH DEPARTMENT
Other - Org Name:SHELBY WEST MIDDLE SATELLITE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-633-1243
Mailing Address - Street 1:1020 HENRY CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1335
Mailing Address - Country:US
Mailing Address - Phone:502-633-1243
Mailing Address - Fax:502-633-7658
Practice Address - Street 1:100 WARRIORS WAY
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8057
Practice Address - Country:US
Practice Address - Phone:502-633-4869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare