Healthcare Provider Details

I. General information

NPI: 1063660454
Provider Name (Legal Business Name): BALLARD COUNTY PRESCHOOL SCHOOL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 PADUCAH RD
BARLOW KY
42024-9704
US

IV. Provider business mailing address

PO BOX 2357
PADUCAH KY
42002-2357
US

V. Phone/Fax

Practice location:
  • Phone: 270-665-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RONALD K. KOSTER
Title or Position: PUBLIC HEALTH DIRECTOR
Credential:
Phone: 270-444-9625