Provider Demographics
NPI:1558345678
Name:WHITLEY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:WHITLEY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT CLERK III
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:606-549-3380
Mailing Address - Street 1:114 NORTH SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769
Mailing Address - Country:US
Mailing Address - Phone:606-549-3380
Mailing Address - Fax:606-549-8940
Practice Address - Street 1:114 NORTH SECOND STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-549-3380
Practice Address - Fax:606-549-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20118014Medicaid
KY8249OtherP10
KY0894OtherMEDICARE GROUP NUMBER
KY0894OtherMEDICARE GROUP NUMBER