Healthcare Provider Details

I. General information

NPI: 1750397139
Provider Name (Legal Business Name): KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 28
BOONEVILLE KY
41314
US

IV. Provider business mailing address

441 GORMAN HOLLOW RD
HAZARD KY
41701-2315
US

V. Phone/Fax

Practice location:
  • Phone: 606-593-5181
  • Fax: 606-593-7438
Mailing address:
  • Phone: 606-439-2361
  • Fax: 606-439-0870

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: MR. ANTHONY SCOTT LOCKARD
Title or Position: PUBLIC HEALTH DIRECTOR IV
Credential: M.S.W., C.S.W.
Phone: 606-439-2361