Provider Demographics
NPI:1033217799
Name:LACLEDE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LACLEDE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BLATTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-532-2134
Mailing Address - Street 1:405 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-2319
Mailing Address - Country:US
Mailing Address - Phone:417-532-2134
Mailing Address - Fax:417-532-6095
Practice Address - Street 1:405 HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2319
Practice Address - Country:US
Practice Address - Phone:417-532-2134
Practice Address - Fax:417-532-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
X22262Medicare UPIN