Healthcare Provider Details

I. General information

NPI: 1174956262
Provider Name (Legal Business Name): SCOTT COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

IV. Provider business mailing address

1471 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

V. Phone/Fax

Practice location:
  • Phone: 812-752-8455
  • Fax: 812-752-6023
Mailing address:
  • Phone: 812-752-8455
  • Fax: 812-752-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number01035467A
License Number StateIN

VIII. Authorized Official

Name: DR. RUSSELL KEVIN ROGERS
Title or Position: PUBLIC HEALTH OFFICER
Credential: M.D.
Phone: 812-752-4656