Healthcare Provider Details

I. General information

NPI: 1689718835
Provider Name (Legal Business Name): LAKE CUMBERLAND DISTRICT HEATLH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 S MAIN ST
JAMESTOWN KY
42629-2199
US

IV. Provider business mailing address

500 BOURNE AVE
SOMERSET KY
42501-1916
US

V. Phone/Fax

Practice location:
  • Phone: 270-343-3966
  • Fax: 270-343-3350
Mailing address:
  • Phone: 606-678-4761
  • Fax: 606-676-9671

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. SHAWN D CRABTREE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-678-4761