Provider Demographics
NPI:1689993099
Name:CLARK COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CLARK COUNTY HEALTH DEPARTMENT
Other - Org Name:GEORGE ROGERS CLARK HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-744-4482
Mailing Address - Street 1:400 PROFESSIONAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1147
Mailing Address - Country:US
Mailing Address - Phone:859-744-4482
Mailing Address - Fax:859-744-0338
Practice Address - Street 1:620 BOONE AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2378
Practice Address - Country:US
Practice Address - Phone:859-744-6111
Practice Address - Fax:859-744-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100119300Medicaid