MEDICARE: KENTUCKY RIVER 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8372	OTHER	KY	MEDICARE GROUP

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	:	1750397139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	441 GORMAN HOLLOW RD
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41701-2315
Country	:	US
Telephone Number	:	606-439-2361
Fax Number	:	606-439-0870

Provider Business Practice Location Address
First Line	:	HIGHWAY 28
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314
Country	:	US
Telephone Number	:	606-593-5181
Fax Number	:	606-593-7438

Authorized Official
Title or Position	:	PUBLIC HEALTH DIRECTOR IV
Name	:	MR. ANTHONY SCOTT LOCKARD
Credential	:	M.S.W., C.S.W.
Telephone Number	:	606-439-2361

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	09/18/2018

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Directions to “KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT ” Practice Location

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