Provider Demographics
NPI:1053468884
Name:PERRY COUNTY
Entity Type:Organization
Organization Name:PERRY COUNTY
Other - Org Name:PERRY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-547-2746
Mailing Address - Street 1:3214 TELL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-2870
Mailing Address - Country:US
Mailing Address - Phone:812-547-2746
Mailing Address - Fax:812-547-0415
Practice Address - Street 1:3214 TELL ST STE 1
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2870
Practice Address - Country:US
Practice Address - Phone:812-547-2746
Practice Address - Fax:812-547-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1174Medicaid