1184740334 NPI number — COUNTY OF MCDONALD

Table of content: (NPI 1184740334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184740334 NPI number — COUNTY OF MCDONALD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MCDONALD
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:
Provider Other Organization Name Type Code:
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:
1184740334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 OLIN ST
Provider Second Line Business Mailing Address:
PO BOX 366
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-223-4351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 OLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64856-0366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-223-4351
Provider Business Practice Location Address Fax Number:
417-223-4109
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEHM
Authorized Official First Name:
PAIGE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
417-223-4351

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 510564017 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com