Provider Demographics
NPI:1114059029
Name:GATEWAY DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GATEWAY DISTRICT HEALTH DEPARTMENT
Other - Org Name:BATH COUNTY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-674-6396
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360
Mailing Address - Country:US
Mailing Address - Phone:606-674-6396
Mailing Address - Fax:606-674-3071
Practice Address - Street 1:68 OBERLINE STREET
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360
Practice Address - Country:US
Practice Address - Phone:606-674-2731
Practice Address - Fax:606-674-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1023051208OtherCINDY CRAGER, ARNP
KY1811246143OtherJESSICA LYKINS, APRN
KY20006011Medicaid
KY1255326104OtherJUDY LEE, ARNP
KY1588668339OtherDR. ESKEW
KY1558561910OtherSANDRA ELLINGTON, MS,RD
KY1376742932OtherWENDY LYKINS, ARNP
KY1023051208OtherCINDY CRAGER, ARNP
KY1255326104OtherJUDY LEE, ARNP