Provider Demographics
NPI:1235223058
Name:COUNTY OF BOONE
Entity Type:Organization
Organization Name:COUNTY OF BOONE
Other - Org Name:BOONE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:815-547-8577
Mailing Address - Street 1:1204 LOGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-4031
Mailing Address - Country:US
Mailing Address - Phone:815-547-8571
Mailing Address - Fax:815-544-2050
Practice Address - Street 1:1204 LOGAN AVENUE
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-4031
Practice Address - Country:US
Practice Address - Phone:815-547-8571
Practice Address - Fax:815-544-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0711587OtherCLIA
IL14D0711587OtherCLIA
IL14D0711587OtherCLIA