Healthcare Provider Details

I. General information

NPI: 1730631946
Provider Name (Legal Business Name): GATEWAY DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DAVID BLAIR BLVD
SANDY HOOK KY
41171
US

IV. Provider business mailing address

PO BOX 555
OWINGSVILLE KY
40360-0555
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-5205
  • Fax: 606-738-6530
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: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 606-674-6396