Provider Demographics
NPI:1265778708
Name:GATEWAY DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:GATEWAY DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-674-6396
Mailing Address - Street 1:42 TREADWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-0005
Mailing Address - Country:US
Mailing Address - Phone:606-674-6396
Mailing Address - Fax:606-674-3071
Practice Address - Street 1:42 TREADWAY DRIVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-0005
Practice Address - Country:US
Practice Address - Phone:606-674-6396
Practice Address - Fax:606-674-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare