Provider Demographics
NPI:1356478549
Name:TAYLOR COUNTY PUBLIC HEALTH AGENCY
Entity Type:Organization
Organization Name:TAYLOR COUNTY PUBLIC HEALTH AGENCY
Other - Org Name:MATERNAL & CHILD HEALTH CENTER OF SW IOWA
Other - Org Type:Other Name
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUNT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:712-523-3405
Mailing Address - Street 1:405 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50833-1300
Mailing Address - Country:US
Mailing Address - Phone:712-523-3405
Mailing Address - Fax:712-523-3402
Practice Address - Street 1:405 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IA
Practice Address - Zip Code:50833-1300
Practice Address - Country:US
Practice Address - Phone:712-523-3405
Practice Address - Fax:712-523-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283945Medicaid