Provider Demographics
NPI:1114387438
Name:THREE RIVERS DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:THREE RIVERS DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFORMATICS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-484-3412
Mailing Address - Street 1:60 OLD MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-9030
Mailing Address - Country:US
Mailing Address - Phone:502-484-3412
Mailing Address - Fax:502-484-0864
Practice Address - Street 1:60 OLD MONTEREY RD
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9030
Practice Address - Country:US
Practice Address - Phone:502-484-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20096012Medicaid
KY20021010Medicaid
KY20094017Medicaid
KY20039012Medicaid