Provider Demographics
NPI:1053385252
Name:GREEN RIVER DISTRICT HEALTH DEPT
Entity type:Organization
Organization Name:GREEN RIVER DISTRICT HEALTH DEPT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:270-686-7747
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0309
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:1336 CLAY ST
Practice Address - Street 2:OHIO COUNTY HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1637
Practice Address - Country:US
Practice Address - Phone:270-298-3663
Practice Address - Fax:270-298-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20092011Medicaid
KY20092011Medicaid