Provider Demographics
NPI:1073795316
Name:LITTLE SANDY DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LITTLE SANDY DISTRICT HEALTH DEPARTMENT
Other - Org Name:CARTER COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THORNBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-474-6685
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:COURTHOUSE
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-0909
Mailing Address - Country:US
Mailing Address - Phone:606-474-6685
Mailing Address - Fax:606-474-0256
Practice Address - Street 1:1710 E US HWY 60
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-0919
Practice Address - Country:US
Practice Address - Phone:606-474-5109
Practice Address - Fax:606-474-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20022018Medicaid
KY1306826094OtherNPI
1396943890OtherNPI
600000633OtherMEDICARE RAILROAD
1538247572OtherNPI
8343Medicare PIN