MEDICARE: MADISON 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	163WH0200X	Home Health Registered Nurse
2	252Y00000X	Early Intervention Provider Agency	150067	KY
3	251E00000X	Home Health Agency	150057	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205833043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	216 BOGGS LN
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2522
Country	:	US
Telephone Number	:	859-623-3441
Fax Number	:	859-626-4283

Provider Business Practice Location Address
First Line	:	216 BOGGS LN
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2522
Country	:	US
Telephone Number	:	859-623-3441
Fax Number	:	859-626-4283

Authorized Official
Title or Position	:	NURSING ADMINISTRATOR
Name	:	MRS. BILLIE DYER JR.
Credential	:	RN
Telephone Number	:	859-626-4501

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/20/2015

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Directions to “MADISON COUNTY HEALTH DEPARTMENT ” Practice Location

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