MEDICARE: MERCER COUNTY HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	14273	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15000755	OTHER	KY	HANDS PROGRAM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023092350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCER COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	900 N COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1089
Country	:	US
Telephone Number	:	859-734-2229
Fax Number	:	859-734-0568

Provider Business Practice Location Address
First Line	:	900 N COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1089
Country	:	US
Telephone Number	:	859-734-2229
Fax Number	:	859-734-2229

Authorized Official
Title or Position	:	ADMIN SPECIALIST
Name	:	MRS. STACY C BLACKETER
Credential	:
Telephone Number	:	859-734-2229

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	04/05/2012

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Directions to “MERCER COUNTY HEALTH DEPARTMENT ” Practice Location

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