MEDICARE: GRAYSON COUNTY HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency		KY

General Provider Information

NPI Number	:	1265774301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAYSON COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	124 E WHITE OAK ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1447
Country	:	US
Telephone Number	:	270-259-3141
Fax Number	:	270-259-5388

Provider Business Practice Location Address
First Line	:	124 E WHITE OAK ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1447
Country	:	US
Telephone Number	:	270-259-3141
Fax Number	:	270-259-5388

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MISS GIGI MEREDITH
Credential	:	R.N.
Telephone Number	:	270-259-3141

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/26/2013

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