Provider Demographics
NPI:1992183933
Name:NORTHERN KENTUKY INDEPENDENT DIST HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:NORTHERN KENTUKY INDEPENDENT DIST HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-363-2040
Mailing Address - Street 1:610 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3416
Mailing Address - Country:US
Mailing Address - Phone:859-341-4264
Mailing Address - Fax:859-578-3689
Practice Address - Street 1:741 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1222
Practice Address - Country:US
Practice Address - Phone:859-491-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare