Provider Demographics
NPI:1730497678
Name:NORTHERN KENTUCKY INDEPENDENT DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY INDEPENDENT DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DISTRICT DIRECTOR OF HEALT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-344-5461
Mailing Address - Street 1:610 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3416
Mailing Address - Country:US
Mailing Address - Phone:859-341-4264
Mailing Address - Fax:859-578-3689
Practice Address - Street 1:2500 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1658
Practice Address - Country:US
Practice Address - Phone:859-655-9545
Practice Address - Fax:859-581-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare