Provider Demographics
NPI:1467505396
Name:DUNKLIN COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:DUNKLIN COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:EPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-9008
Mailing Address - Street 1:402 RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3235
Mailing Address - Country:US
Mailing Address - Phone:573-888-9008
Mailing Address - Fax:573-888-1629
Practice Address - Street 1:402 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3235
Practice Address - Country:US
Practice Address - Phone:573-888-9008
Practice Address - Fax:573-888-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511146201Medicaid
MO511146201Medicaid