Provider Demographics
NPI:1023151842
Name:PURCHASE DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:PURCHASE DISTRICT HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-9625
Mailing Address - Street 1:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-2357
Mailing Address - Country:US
Mailing Address - Phone:270-444-9625
Mailing Address - Fax:
Practice Address - Street 1:2750 MOSCOW AVE
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:KY
Practice Address - Zip Code:42050-2046
Practice Address - Country:US
Practice Address - Phone:270-236-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20038014Medicaid