Provider Demographics
NPI:1912041641
Name:LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAKE CUMBERLAND DISTRICT HEALTH DEPARTMENT
Other - Org Name:PULASKI COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-678-4761
Mailing Address - Street 1:500 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1916
Mailing Address - Country:US
Mailing Address - Phone:606-678-4761
Mailing Address - Fax:606-676-9671
Practice Address - Street 1:45 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1295
Practice Address - Country:US
Practice Address - Phone:606-679-4416
Practice Address - Fax:606-679-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1316135783OtherNPI RENDERING PROVIDER
KY1760469134OtherNPI RENDERING PROVIDER
KY1073590436OtherNPI RENDERING PROVIDER
KY1568647824OtherNPI RENDERING PROVIDER
KY1629055082OtherNPI RENDERING PROVIDER
KY1770560716OtherNPI RENDERING PROVIDER
KY15001324OtherHANDS MEDICAID
KY1265410393OtherNPI RENDERING PROVIDER
KY1437271244OtherNPI RENDERING PROVIDER
KY1588825335OtherNPI RENDERING PROVIDER
KY20100012Medicaid
KY0300402OtherMEDICARE PROVIDER
KY50003866OtherPASSPORT MEDICAID
KY000000047568OtherBC/BS PROVIDER NUMBER
KY1427035872OtherNPI RENDERING PROVIDER
KY1568449445OtherNPI RENDERING PROVIDER
KY1780687798OtherNPI RENDERING PROVIDER
KY600000718OtherRR MEDICARE
KY1770560716OtherNPI RENDERING PROVIDER