Provider Demographics
NPI:1942790167
Name:LAUREL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAUREL COUNTY HEALTH DEPARTMENT
Other - Org Name:LAUREL COUNTY HEALTH DEPARTMENT #2
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-864-5244
Mailing Address - Street 1:525 WHITLEY ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2626
Mailing Address - Country:US
Mailing Address - Phone:606-864-5187
Mailing Address - Fax:606-864-8295
Practice Address - Street 1:525 WHITLEY ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2626
Practice Address - Country:US
Practice Address - Phone:606-864-5187
Practice Address - Fax:606-864-8295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY133V00000X, 2083P0901X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20063012Medicaid