Healthcare Provider Details

I. General information

NPI: 1811152408
Provider Name (Legal Business Name): LAUREL COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WHITLEY ST
LONDON KY
40741-2626
US

IV. Provider business mailing address

525 WHITLEY ST
LONDON KY
40741-2626
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-7754
  • Fax: 606-864-8295
Mailing address:
  • Phone: 606-878-7754
  • Fax: 606-864-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number261QP0905X
License Number StateKY

VIII. Authorized Official

Name: MR. MARK A HENSLEY
Title or Position: DIRECTOR
Credential:
Phone: 606-878-7754