NPIMap

Organization Active NPI

Pennyrile District Health Department

Doing business as Crittenden County Firecracker Star Clinic

  • Public Health or Welfare Agency
  • Marion, KY
National Provider Identifier
1396927745
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
PENNYRILE DISTRICT HEALTH DEPARTMENT
Doing business as
Crittenden County Firecracker Star Clinic
Practice address
120 Autumn LN
Marion, KY 42064-1877
Phone
(270) 388-9747
Fax
(270) 388-9747
NPI assigned
Nov 28, 2007
Last updated
Oct 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PENNYRILE DISTRICT HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elisha Kite
Title
Director
Phone
(270) 388-9747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X KY Primary

Addresses

Primary practice location

120 Autumn LN
Marion, KY 42064-1877

Mailing address

PO Box 770
Eddyville, KY 42038-0770
Phone (270) 388-9747

Other identifiers 1

IdentifierTypeStateIssuer
7100003680MedicaidKY

Other names 1

  • Crittenden County Firecracker Star Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Crittenden Co Health de20 organizations share this tax ID, including this one
Part of
Crittenden Co Health de

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1396927745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770",
            "city": "EDDYVILLE",
            "state": "KY",
            "postal_code": "420380770",
            "telephone_number": "270-388-9747",
            "fax_number": "270-388-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 AUTUMN LN",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641877",
            "telephone_number": "270-388-9747",
            "fax_number": "270-388-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNYRILE DISTRICT HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENNYRILE DISTRICT HEALTH DEPARTMENT",
        "enumeration_date": "2007-11-28",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "KITE",
        "authorized_official_first_name": "ELISHA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "270-388-9747"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100003680",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crittenden County Firecracker Star Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crittenden County Firecracker Star Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.