Provider Demographics
NPI:1790998656
Name:MENIFEE CO HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MENIFEE CO HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-674-6396
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360
Mailing Address - Country:US
Mailing Address - Phone:606-674-6396
Mailing Address - Fax:606-674-3071
Practice Address - Street 1:1919 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-1919
Practice Address - Country:US
Practice Address - Phone:606-768-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY DISTRICT HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY15001076Medicaid