Provider Demographics
NPI:1801225206
Name:MERCER COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:MERCER COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLACKETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-734-2229
Mailing Address - Street 1:900 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1089
Mailing Address - Country:US
Mailing Address - Phone:859-734-2229
Mailing Address - Fax:859-734-0538
Practice Address - Street 1:900 NORTH COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330
Practice Address - Country:US
Practice Address - Phone:859-734-2229
Practice Address - Fax:859-734-0568
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT FOR PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-06
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14273251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY15000755OtherHANDS PROGRAM
KY200848018Medicaid
KY15000755OtherHANDS PROGRAM
KY200848018Medicaid