Provider Demographics
NPI:1871669036
Name:KNOX COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KNOX COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-546-3486
Mailing Address - Street 1:261 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7356
Mailing Address - Country:US
Mailing Address - Phone:606-546-3486
Mailing Address - Fax:606-546-2867
Practice Address - Street 1:261 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7356
Practice Address - Country:US
Practice Address - Phone:606-546-3486
Practice Address - Fax:606-546-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20061016Medicaid
8368Medicare PIN