Provider Demographics
NPI:1578680757
Name:PENNYRILE DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PENNYRILE DISTRICT HEALTH DEPARTMENT
Other - Org Name:TRIGG COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BESHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-388-9747
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-0191
Mailing Address - Country:US
Mailing Address - Phone:270-522-8121
Mailing Address - Fax:270-522-5384
Practice Address - Street 1:196 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211
Practice Address - Country:US
Practice Address - Phone:270-522-8121
Practice Address - Fax:270-522-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20111019Medicaid
KY15000847Medicaid
KY74353Medicare UPIN
KY600002377Medicare PIN
KY15000847Medicaid