Healthcare Provider Details

I. General information

NPI: 1053404210
Provider Name (Legal Business Name): ESTILL COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 RIVER DR
IRVINE KY
40336-1284
US

IV. Provider business mailing address

365 RIVER DRIVE PO BOX 115
IRVINE KY
40336-0115
US

V. Phone/Fax

Practice location:
  • Phone: 606-723-5181
  • Fax: 606-723-5254
Mailing address:
  • Phone: 606-723-5181
  • Fax: 606-723-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. ELIZABETH B WALLING
Title or Position: DIRECTOR
Credential:
Phone: 606-723-5181