Provider Demographics
NPI:1982747804
Name:PURCHASE DISTRICT HEALTH DEPT
Entity Type:Organization
Organization Name:PURCHASE DISTRICT HEALTH DEPT
Other - Org Name:HICKMAN COUNTY SCHOOL CLINI
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-9625
Mailing Address - Street 1:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-2357
Mailing Address - Country:US
Mailing Address - Phone:270-444-9625
Mailing Address - Fax:
Practice Address - Street 1:416 MCMORRIS ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:KY
Practice Address - Zip Code:42031-1244
Practice Address - Country:US
Practice Address - Phone:270-653-4067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20053013Medicaid