Provider Demographics
NPI:1295952604
Name:LEWIS COUNTY HEALTH DEPT
Entity type:Organization
Organization Name:LEWIS COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SU
Authorized Official - Last Name:ELLIOTT-FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSW
Authorized Official - Phone:606-796-2632
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:LEWIS COUNTY HEALTH DEPARTMENT
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179
Mailing Address - Country:US
Mailing Address - Phone:606-796-2632
Mailing Address - Fax:606-796-9285
Practice Address - Street 1:185 COMMERCIAL DRIVE
Practice Address - Street 2:LEWIS COUNTY HEALTH DEPARTMENT
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179
Practice Address - Country:US
Practice Address - Phone:606-796-2632
Practice Address - Fax:606-796-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2010-05-18
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20068011Medicaid
KY20068011Medicaid