Provider Demographics
NPI:1609108604
Name:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:MORGANFIELD ELEMENTARY SCHOOL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:270-686-7747
Mailing Address - Street 1:1501 BRECKENRIDGE ST
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1054
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:511 S MART ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1723
Practice Address - Country:US
Practice Address - Phone:270-389-2611
Practice Address - Fax:270-389-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid