Healthcare Provider Details

I. General information

NPI: 1265778708
Provider Name (Legal Business Name): GATEWAY DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 TREADWAY DRIVE
OWINGSVILLE KY
40360-0005
US

IV. Provider business mailing address

42 TREADWAY DRIVE
OWINGSVILLE KY
40360-0005
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-6396
  • Fax: 606-674-3071
Mailing address:
  • Phone: 606-674-6396
  • Fax: 606-674-3071

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. GREGORY D BREWER
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 606-674-6396