Provider Demographics
NPI:1114174935
Name:DADE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:DADE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-637-2345
Mailing Address - Street 1:413 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65661-1353
Mailing Address - Country:US
Mailing Address - Phone:417-637-2345
Mailing Address - Fax:417-637-2507
Practice Address - Street 1:413 W WATER ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-1353
Practice Address - Country:US
Practice Address - Phone:417-637-2345
Practice Address - Fax:417-637-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO512460304Medicaid
MO000045001Medicare PIN