Healthcare Provider Details

I. General information

NPI: 1114059029
Provider Name (Legal Business Name): GATEWAY DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 OBERLINE STREET
OWINGSVILLE KY
40360
US

IV. Provider business mailing address

PO BOX 555
OWINGSVILLE KY
40360
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-2731
  • Fax: 606-674-9646
Mailing address:
  • Phone: 606-674-6396
  • Fax: 606-674-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GREGORY D BREWER
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 606-674-6396