Provider Demographics
NPI:1205095619
Name:UNIVERSITY OF KENTUCKY NORTHFORK VALLEY COUMMUNITY HEALTH BOARD, INC.
Entity type:Organization
Organization Name:UNIVERSITY OF KENTUCKY NORTHFORK VALLEY COUMMUNITY HEALTH BOARD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-436-1559
Mailing Address - Street 1:750 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9469
Mailing Address - Country:US
Mailing Address - Phone:606-439-1559
Mailing Address - Fax:
Practice Address - Street 1:59 COWTOWN ROAD
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822-9120
Practice Address - Country:US
Practice Address - Phone:606-785-3175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF KENTUCKY NORTH FORK VALLEY COUMMUNITY HEALTH BOARD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty