Provider Demographics
NPI:1417469537
Name:KNOX COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KNOX COUNTY HEALTH DEPARTMENT
Other - Org Name:KNOX COUNTY HEALTH DEPARTMENT HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOOTS-CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-397-3396
Mailing Address - Street 1:102 W MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MO
Mailing Address - Zip Code:63537-1150
Mailing Address - Country:US
Mailing Address - Phone:660-397-3396
Mailing Address - Fax:660-397-3579
Practice Address - Street 1:102 W MONTICELLO ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-1150
Practice Address - Country:US
Practice Address - Phone:660-397-3396
Practice Address - Fax:660-397-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251K00000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO581942505Medicaid