Provider Demographics
NPI:1225358492
Name:PAINTSVILLE HIGH SCHOOL
Entity Type:Organization
Organization Name:PAINTSVILLE HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-789-2590
Mailing Address - Street 1:630 JAMES S TRIMBLE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1026
Mailing Address - Country:US
Mailing Address - Phone:606-789-2590
Mailing Address - Fax:606-789-8888
Practice Address - Street 1:225 2ND ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1001
Practice Address - Country:US
Practice Address - Phone:606-789-2590
Practice Address - Fax:606-789-8888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON COUNTY HEALTH DEPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20058012Medicaid
KY0746Medicare PIN