Provider Demographics
NPI:1902000631
Name:GREENUP CO HEALTH DEPT
Entity Type:Organization
Organization Name:GREENUP CO HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-473-9838
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-0377
Mailing Address - Country:US
Mailing Address - Phone:606-473-9838
Mailing Address - Fax:606-473-6405
Practice Address - Street 1:806 SEATON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1196
Practice Address - Country:US
Practice Address - Phone:606-473-9838
Practice Address - Fax:606-473-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYST37217251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1285897652OtherNPI FOR APRN
KY15000052Medicaid
KY1285897652OtherNPI FOR ARNP
KY15000052OtherHANDS
KY600000625OtherRAILROAD MEDICARE
KY0274004Medicare PIN
KY600000625OtherRAILROAD MEDICARE
KYC71783Medicare UPIN