Provider Demographics
NPI:1578744603
Name:POWELL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:POWELL COUNTY HEALTH DEPARTMENT
Other - Org Name:CLAY CITY ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-663-4360
Mailing Address - Street 1:376 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2169
Mailing Address - Country:US
Mailing Address - Phone:606-663-4360
Mailing Address - Fax:606-663-9790
Practice Address - Street 1:4901 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312-1138
Practice Address - Country:US
Practice Address - Phone:606-663-4360
Practice Address - Fax:606-663-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20099032Medicaid