Provider Demographics
NPI:1871763581
Name:EAST KENTUCKY HEALTH SERVICE
Entity type:Organization
Organization Name:EAST KENTUCKY HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-785-3164
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-0849
Mailing Address - Country:US
Mailing Address - Phone:606-785-3164
Mailing Address - Fax:606-785-0107
Practice Address - Street 1:566 HWY 899
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-785-3164
Practice Address - Fax:606-785-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16312261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64163124Medicaid
KY000000287060OtherBLUE CROSS PIN NUMBER
KY0751OtherMEDICARE GROUP NUMBER
KY65924300Medicaid
KY080188437OtherMEDICARE RAILROAD NUMBER
KY080188437OtherMEDICARE RAILROAD NUMBER
KY65924300Medicaid