1912904145 NPI number — DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912904145 NPI number — DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MISSOURI OZARKS COMMUNITY HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912904145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1359
Provider Second Line Business Mailing Address:
504 NW 10TH AVE
Provider Business Mailing Address City Name:
AVA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65608-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-683-4831
Provider Business Mailing Address Fax Number:
417-683-1602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 NW 10TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65608-1359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-683-4831
Provider Business Practice Location Address Fax Number:
417-683-1602
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
417-683-4831

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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