Healthcare Provider Details

I. General information

NPI: 1912395138
Provider Name (Legal Business Name): MADISON COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 BOGGS LN
RICHMOND KY
40475-2522
US

IV. Provider business mailing address

216 BOGGS LN
RICHMOND KY
40475-2522
US

V. Phone/Fax

Practice location:
  • Phone: 859-626-4502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: NANCY CREWE
Title or Position: DIRECTOR
Credential:
Phone: 859-626-4241