Healthcare Provider Details

I. General information

NPI: 1669504023
Provider Name (Legal Business Name): CANNEL CITY ELEMENTARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENERAL DELIVERY
CANNEL CITY KY
41408
US

IV. Provider business mailing address

PO BOX 555
OWINGSVILLE KY
40360
US

V. Phone/Fax

Practice location:
  • Phone: 606-743-8253
  • Fax:
Mailing address:
  • Phone: 606-674-6396
  • Fax: 606-674-3071

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. GREGORY D BREWER
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 606-674-6396