Provider Demographics
NPI:1235359449
Name:COUNTY OF CRAWFORD
Entity Type:Organization
Organization Name:COUNTY OF CRAWFORD
Other - Org Name:CRAWFORD COUNTY NURSING SERVICE/HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:STULCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-775-2555
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:202 W MAIN ST
Mailing Address - City:STEELVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65565-0367
Mailing Address - Country:US
Mailing Address - Phone:573-775-2555
Mailing Address - Fax:573-775-3826
Practice Address - Street 1:518 PINE ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-6041
Practice Address - Country:US
Practice Address - Phone:573-775-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CRAWFORD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-27
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105130251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO045064Medicare ID - Type UnspecifiedNUMBER FOR HEALTH DEPT