Healthcare Provider Details

I. General information

NPI: 1497803100
Provider Name (Legal Business Name): EDMONSON COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILDCAT WAY
BROWNSVILLE KY
42210
US

IV. Provider business mailing address

PO BOX 129
BROWNSVILLE KY
42210
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2101
  • Fax: 270-597-2103
Mailing address:
  • Phone: 270-597-2101
  • Fax: 270-597-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. WYN CAUDILL
Title or Position: DOSE DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 270-597-2101