Provider Demographics
NPI:1265639546
Name:WHITLEY COUNTY HEALTH DEPT.
Entity Type:Organization
Organization Name:WHITLEY COUNTY HEALTH DEPT.
Other - Org Name:WHITLEY CO. HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:606-549-3380
Mailing Address - Street 1:114 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1101
Mailing Address - Country:US
Mailing Address - Phone:606-549-3380
Mailing Address - Fax:606-549-8940
Practice Address - Street 1:114 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1101
Practice Address - Country:US
Practice Address - Phone:606-549-3380
Practice Address - Fax:606-549-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20118048Medicaid