Provider Demographics
NPI:1598748071
Name:MONTGOMERY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-498-3808
Mailing Address - Street 1:117 CIVIC CTR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1478
Mailing Address - Country:US
Mailing Address - Phone:859-498-3808
Mailing Address - Fax:859-498-9082
Practice Address - Street 1:117 CIVIC CTR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1478
Practice Address - Country:US
Practice Address - Phone:859-498-3808
Practice Address - Fax:859-498-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20087011Medicaid
KYFLU0214Medicare PIN
KY9845Medicare PIN