Provider Demographics
NPI:1427233592
Name:CLARK COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CLARK COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:859-744-4482
Mailing Address - Street 1:400 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1147
Mailing Address - Country:US
Mailing Address - Phone:859-744-4482
Mailing Address - Fax:859-737-2426
Practice Address - Street 1:244 E. BROADWAY
Practice Address - Street 2:SHEARER ELEMENTARY SCHOOL
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-744-4978
Practice Address - Fax:859-745-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20025045Medicaid