1972584340 NPI number — AUDRAIN COUNTY HEALTH CENTER

Table of content: MS. ERIN KATIE DUNN LICSW, CN (NPI 1659750206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972584340 NPI number — AUDRAIN COUNTY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDRAIN COUNTY HEALTH CENTER
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:
6
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:
1972584340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 S ELMWOOD
Provider Second Line Business Mailing Address:
P.O. BOX 957
Provider Business Mailing Address City Name:
MEXICO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65265-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-581-6060
Provider Business Mailing Address Fax Number:
573-581-6652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 S ELMWOOD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEXICO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65265-0957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-581-6060
Provider Business Practice Location Address Fax Number:
573-581-6652
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD CHAIRPERSON
Authorized Official Telephone Number:
573-581-1332

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 820328102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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