Organization
GREEN RIVER DISTRICT HEALTH DEPARTMENT
Active
Other names
Providence Elementary Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL THOMPSON (ADMINISTRATIVE SERVICE MANAGER)
(270) 686-7747
Entity
Organization
Contact information
Practice address
470 S BROADWAY ST, PROVIDENCE, KY 42450-1642
(270) 667-7041
(270) 667-5893
Mailing address
470 S BROADWAY ST, PROVIDENCE, KY 42450-1642
(270) 667-7041
(270) 667-5893
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100001710
—
KY
Enumeration date
08/15/2007
Last updated
12/23/2008
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