Provider Demographics
NPI:1700858552
Name:NORTH CENTRAL DISTRICT HEALTH DEPT.
Entity Type:Organization
Organization Name:NORTH CENTRAL DISTRICT HEALTH DEPT.
Other - Org Name:SHELBY COUNTY HEALTH DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR-STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:502-633-1243
Mailing Address - Street 1:1020 HENRY CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065
Mailing Address - Country:US
Mailing Address - Phone:502-633-1243
Mailing Address - Fax:502-633-7658
Practice Address - Street 1:615 11TH ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065
Practice Address - Country:US
Practice Address - Phone:502-633-1231
Practice Address - Fax:502-633-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20106019Medicaid
KYFLU0295OtherMEDICARE-FLU
KY15000730OtherHANDS-MEDICAID
KYK139110OtherMEDICARE PTAN
50001016OtherPASSPORT