Healthcare Provider Details

I. General information

NPI: 1316360167
Provider Name (Legal Business Name): EAST PERRY ELEMENTARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 E KY HIGHWAY 80
HAZARD KY
41701-8516
US

IV. Provider business mailing address

1559 E KY HIGHWAY 80
HAZARD KY
41701-8516
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-3423
  • Fax: 606-439-3353
Mailing address:
  • Phone: 606-436-3423
  • Fax: 606-439-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS NEACE
Title or Position: PRINCIPAL
Credential:
Phone: 606-436-3423