Provider Demographics
NPI:1184621369
Name:WHITLEY COUNTY COUNTY TREASURER
Entity type:Organization
Organization Name:WHITLEY COUNTY COUNTY TREASURER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-539-0867
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:994 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-9884
Practice Address - Country:US
Practice Address - Phone:606-539-0867
Practice Address - Fax:606-539-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-04
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56017866Medicaid
KY000000191494OtherANTHEM BLUE CROSS
205044500OtherFEDERAL BLACK LUNG PROGRAM
TN4582224Medicaid
KY55118053Medicaid
TN4582224Medicaid
KY55118053Medicaid