Provider Demographics
NPI:1184805608
Name:BRACKEN COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:BRACKEN COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISRTATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-735-2157
Mailing Address - Street 1:429 FRANKFORT STREET
Mailing Address - Street 2:PO BOX 117
Mailing Address - City:BROOKSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41004
Mailing Address - Country:US
Mailing Address - Phone:606-735-2157
Mailing Address - Fax:606-735-2747
Practice Address - Street 1:WEST MIAMI
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004
Practice Address - Country:US
Practice Address - Phone:606-735-2157
Practice Address - Fax:606-735-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20000352Medicaid