Provider Demographics
NPI:1275641938
Name:COUNTY OF CALLAWAY
Entity Type:Organization
Organization Name:COUNTY OF CALLAWAY
Other - Org Name:CALLAWAY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-642-6881
Mailing Address - Street 1:4950 COUNTY ROAD 304
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-5422
Mailing Address - Country:US
Mailing Address - Phone:573-642-6881
Mailing Address - Fax:573-642-2098
Practice Address - Street 1:4950 COUNTY ROAD 304
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-5422
Practice Address - Country:US
Practice Address - Phone:573-642-6881
Practice Address - Fax:573-642-2098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CALLAWAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000045095Medicare PIN