Provider Demographics
NPI:1497887772
Name:GATEWAY DISTRICT HEALTH DEPT
Entity Type:Organization
Organization Name:GATEWAY DISTRICT HEALTH DEPT
Other - Org Name:MENIFEE CO HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-674-6396
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360
Mailing Address - Country:US
Mailing Address - Phone:606-674-6396
Mailing Address - Fax:606-674-3071
Practice Address - Street 1:1919 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322
Practice Address - Country:US
Practice Address - Phone:606-768-2151
Practice Address - Fax:606-768-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1811246143OtherJESSICA LYKINS, APRN
KY1588668339OtherDR. ESKEW
KY1255326104OtherJUDY LEE, ARNP
KY20083010Medicaid
KY1558561910OtherSANDRA ELLINGTON, MS,RD
KY1023051208OtherCINDY CRAGER, ARNP
KY1376742932OtherWENDY LYKIINS, ARNP
KYFLU0347Medicare PIN
KY1255326104OtherJUDY LEE, ARNP