MEDICARE: THREE RIVERS DISTRICT 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		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

General Provider Information

NPI Number	:	1548354764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE RIVERS DISTRICT HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	60 OLD MONTEREY RD
Second Line	:
City	:	OWENTON
State	:	KY
Zip	:	40359-9030
Country	:	US
Telephone Number	:	502-484-3412
Fax Number	:	502-484-0864

Provider Business Practice Location Address
First Line	:	102 W PEARL ST
Second Line	:
City	:	WARSAW
State	:	KY
Zip	:	41095-2029
Country	:	US
Telephone Number	:	859-567-2844
Fax Number	:	859-567-2845

Authorized Official
Title or Position	:	DISTRICT DIRECTOR
Name	:	MRS. GEORGIA HEISE
Credential	:	DRPH
Telephone Number	:	502-484-3412

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/26/2023

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