Provider Demographics
NPI:1336312180
Name:INEZ ELEMENTARY SCHOOL CLINIC
Entity Type:Organization
Organization Name:INEZ ELEMENTARY SCHOOL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-298-7752
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:136 ROCKCASTLE ROAD
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-0346
Mailing Address - Country:US
Mailing Address - Phone:606-298-7752
Mailing Address - Fax:606-298-0413
Practice Address - Street 1:5000 ELEMENTARY DR
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-9538
Practice Address - Country:US
Practice Address - Phone:606-298-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-11
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200800160Medicaid
KY0736Medicare PIN