Provider Demographics
NPI:1578771978
Name:MADISON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MADISON COUNTY HEALTH DEPARTMENT
Other - Org Name:BEREA HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CREWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-626-4241
Mailing Address - Street 1:214 BOGGS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 ACE DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1327
Practice Address - Country:US
Practice Address - Phone:859-986-1192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY71000008Medicaid
KY20076014Medicaid
KY20076022Medicaid
KY15900004Medicaid
KYFLUO101Medicare PIN
KY0777Medicare PIN