Healthcare Provider Details

I. General information

NPI: 1699001834
Provider Name (Legal Business Name): LEWIS COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST KENTUCKY 10
GARRISON KY
41141
US

IV. Provider business mailing address

PO BOX 219 185 COMMERCIAL DRIVE
VANCEBURG KY
41179-0219
US

V. Phone/Fax

Practice location:
  • Phone: 606-796-2632
  • Fax: 606-796-9285
Mailing address:
  • Phone: 606-796-2632
  • Fax: 606-796-9285

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: MRS. ANITA JO BERTRAM
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: L.S.W., L.N.H.A
Phone: 606-796-2632