Provider Demographics
NPI:1861479206
Name:JESSAMINE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:JESSAMINE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-885-4149
Mailing Address - Street 1:210 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1252
Mailing Address - Country:US
Mailing Address - Phone:859-885-4149
Mailing Address - Fax:859-885-1863
Practice Address - Street 1:210 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1252
Practice Address - Country:US
Practice Address - Phone:859-885-4149
Practice Address - Fax:859-885-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP0905X
KY261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20057014Medicaid
KYFLU0309OtherMEDICARE FLU
KY8350Medicare PIN