Healthcare Provider Details

I. General information

NPI: 1780916783
Provider Name (Legal Business Name): GREEN RIVER DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N GRANT ST
STURGIS KY
42459-1262
US

IV. Provider business mailing address

1501 BRECKENRIDGE ST PO BOX 309
OWENSBORO KY
42303-1054
US

V. Phone/Fax

Practice location:
  • Phone: 270-333-4088
  • Fax: 270-333-4820
Mailing address:
  • Phone: 270-686-7747
  • Fax: 270-926-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. ANGEL THOMPSON
Title or Position: ADMIN SERVICES MANAGER
Credential: M.S.M.
Phone: 270-686-7747