Provider Demographics
NPI:1003881384
Name:BOLLINGER COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:BOLLINGER COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-238-2817
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:107 HWY 51N
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-0409
Mailing Address - Country:US
Mailing Address - Phone:573-238-2817
Mailing Address - Fax:573-238-3085
Practice Address - Street 1:107 HWY 51 N
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-0409
Practice Address - Country:US
Practice Address - Phone:573-238-2817
Practice Address - Fax:573-238-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO510903701Medicaid
MO000045080Medicare ID - Type UnspecifiedGROUP NUMBER