Provider Demographics
NPI:1336283878
Name:LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Other - Org Name:MCCREARY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-678-4761
Mailing Address - Street 1:500 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1916
Mailing Address - Country:US
Mailing Address - Phone:606-678-4761
Mailing Address - Fax:606-676-9671
Practice Address - Street 1:119 MEDICAL LANE
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653
Practice Address - Country:US
Practice Address - Phone:606-376-8775
Practice Address - Fax:606-376-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1316135783OtherNPI RENDERING PROVIDER
KY1770560716OtherNPI RENDERING PROVIDER
KY1780687798OtherNPI RENDERING PROVIDER
KY1427035872OtherNPI RENDERING PROVIDER
KY15000706OtherHANDS MEDICAID
KY1730326877OtherRENDERING PROVIDER
KY600000717OtherRR MEDICARE
KY1356640668OtherNPI RENDERING PROVIDER
KY0300102OtherMEDICARE PROVIDER
KY1568449445OtherNPI RENDERING PROVIDER
KY000000047568OtherBC/BS PROVIDER NUMBER
KY50003866OtherPASSPORT MEDICAID
KY1760469134OtherNPI RENDERING PROVIDER
KY1073590436OtherNPI RENDERING PROVIDER
KY1265410393OtherNPI RENDERING PROVIDER
KY1437271244OtherNPI RENDERING PROVIDER
KY1588825335OtherNPI RENDERING PROVIDER
KY1629055082OtherNPI RENDERING PROVIDER
KY20074019Medicaid
KY0300102OtherMEDICARE PROVIDER