Provider Demographics
NPI:1912976069
Name:CHRISTIAN COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CHRISTIAN COUNTY HEALTH DEPARTMENT
Other - Org Name:CHRISTIAN COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNT CLERK II
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-887-4160
Mailing Address - Street 1:1700 CANTON ST
Mailing Address - Street 2:POST OFFICE BOX 647
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1923
Mailing Address - Country:US
Mailing Address - Phone:270-887-4160
Mailing Address - Fax:270-886-6192
Practice Address - Street 1:1700 CANTON ST
Practice Address - Street 2:POST OFFICE BOX 647
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1923
Practice Address - Country:US
Practice Address - Phone:270-887-4160
Practice Address - Fax:270-886-6192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY15000029OtherHANDS
KY20024014OtherMEDICAID
KY000000072598OtherANTHEM
KY2110OtherGROUP NUMBER
KYP00038381OtherRAILROAD MEDICARE
KYP00038381OtherRAILROAD MEDICARE
KY20024014OtherMEDICAID