Provider Demographics
NPI:1073591327
Name:WEDCO DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:WEDCO DISTRICT HEALTH DEPARTMENT
Other - Org Name:NICHOLAS COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-234-8750
Mailing Address - Street 1:302 ODDVILLE AVE
Mailing Address - Street 2:P O BOX 218
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1241
Mailing Address - Country:US
Mailing Address - Phone:859-234-8750
Mailing Address - Fax:859-234-8925
Practice Address - Street 1:2320 CONCRETE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9721
Practice Address - Country:US
Practice Address - Phone:859-289-2188
Practice Address - Fax:859-289-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20091013Medicaid
KYFLU0107Medicare PIN
KY7390Medicare PIN