Provider Demographics
NPI:1326574567
Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISENAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-6643
Mailing Address - Street 1:1319 E HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3682
Mailing Address - Country:US
Mailing Address - Phone:660-263-6643
Mailing Address - Fax:660-263-0333
Practice Address - Street 1:1319 E HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3682
Practice Address - Country:US
Practice Address - Phone:660-263-6643
Practice Address - Fax:660-263-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-8959Medicare UPIN