Provider Demographics
NPI:1235118324
Name:JEFFERSON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HEALTH DEPARTMENT
Other - Org Name:JEFFERSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-797-3737
Mailing Address - Street 1:405 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050
Mailing Address - Country:US
Mailing Address - Phone:636-789-3372
Mailing Address - Fax:636-797-4631
Practice Address - Street 1:405 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050
Practice Address - Country:US
Practice Address - Phone:636-789-3372
Practice Address - Fax:636-797-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO512084500Medicaid