Provider Demographics
NPI:1700102852
Name:BARREN RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BARREN RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:BARREN RIVER DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-781-8039
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1157
Mailing Address - Country:US
Mailing Address - Phone:270-781-8039
Mailing Address - Fax:270-796-8946
Practice Address - Street 1:1109 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2648
Practice Address - Country:US
Practice Address - Phone:270-781-8039
Practice Address - Fax:270-796-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY303114ZOtherCLINIC SITE
KY7100120040Medicaid