Provider Demographics
NPI:1780716159
Name:GATEWAY DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:GATEWAY DISTRICT HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
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:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360
Mailing Address - Country:US
Mailing Address - Phone:606-674-6396
Mailing Address - Fax:606-674-3071
Practice Address - Street 1:493 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472
Practice Address - Country:US
Practice Address - Phone:606-743-3744
Practice Address - Fax:606-743-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20088019Medicaid
KY1376742932OtherWENDY LYKINS, ARNP
1588668339OtherDR. ESKEW
KY1811246143OtherJESSICA LYKINS, APRN
KY1023051208OtherCINDY CRAGER, ARNP
KY1255326104OtherJUDY LEE, ARNP
KY1558561910OtherSANDRA ELLINGTON, MS,RD
KY1376742932OtherWENDY LYKINS, ARNP
KY1558561910OtherSANDRA ELLINGTON, MS,RD