Provider Demographics
NPI:1174649941
Name:BENTON COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:BENTON COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIEBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-438-2876
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-0935
Mailing Address - Country:US
Mailing Address - Phone:660-438-2876
Mailing Address - Fax:660-438-5746
Practice Address - Street 1:1220 COMMERCIAL STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355
Practice Address - Country:US
Practice Address - Phone:660-438-2876
Practice Address - Fax:660-438-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO262062102Medicaid