MEDICARE: NORTHERN KENTUCKY INDEPENDENT DISTRICT 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

General Provider Information

NPI Number	:	1639319643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN KENTUCKY INDEPENDENT DISTRICT HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	610 MEDICAL VILLAGE DR
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-3416
Country	:	US
Telephone Number	:	859-341-4264
Fax Number	:	859-578-3689

Provider Business Practice Location Address
First Line	:	150 ADELA AVE
Second Line	:
City	:	LUDLOW
State	:	KY
Zip	:	41016-1469
Country	:	US
Telephone Number	:	859-431-7242
Fax Number	:	859-578-3689

Authorized Official
Title or Position	:	DISTRICT DIRECTOR OF HEALTH
Name	:	DR. STEVEN R KATKOWSKY
Credential	:	M.D,
Telephone Number	:	859-341-4264

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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