Provider Demographics
NPI:1326200593
Name:PENNYRILE DISTRICT HEALTH DEPT
Entity Type:Organization
Organization Name:PENNYRILE DISTRICT HEALTH DEPT
Other - Org Name:LIVINGSTON COUNTY HIGH SCHOOL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-388-9747
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-0770
Mailing Address - Country:US
Mailing Address - Phone:270-388-9747
Mailing Address - Fax:
Practice Address - Street 1:750 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:KY
Practice Address - Zip Code:42081-8983
Practice Address - Country:US
Practice Address - Phone:270-388-9747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare