Provider Demographics
NPI:1003142449
Name:LEWIS COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:LEWIS COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, LNHA
Authorized Official - Phone:606-796-2632
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:185 COMMERICAL DRIVE
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0219
Mailing Address - Country:US
Mailing Address - Phone:606-796-2632
Mailing Address - Fax:606-796-9285
Practice Address - Street 1:86 WALTER ST
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-5445
Practice Address - Country:US
Practice Address - Phone:606-796-2632
Practice Address - Fax:606-796-9285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20068011Medicaid
KYFLU0254OtherMEDICARE ID-TYPE UNSPECIFIED