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	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1912395138
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 BOGGS LN
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2522
Country	:	US
Telephone Number	:	859-626-4502
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NANCY CREWE
Credential	:
Telephone Number	:	859-626-4241

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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