Provider Demographics
NPI:1528395100
Name:TODD COUNTY CENTRAL HIGH SCHOOL CLINIC
Entity Type:Organization
Organization Name:TODD COUNTY CENTRAL HIGH SCHOOL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. SPEC. II
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-265-2362
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-0305
Mailing Address - Country:US
Mailing Address - Phone:270-265-2362
Mailing Address - Fax:270-265-0602
Practice Address - Street 1:806 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-8812
Practice Address - Country:US
Practice Address - Phone:270-265-2362
Practice Address - Fax:270-265-0602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TODD COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-03
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20110011Medicaid
KY20110011Medicaid