Provider Demographics
NPI:1477538825
Name:CAPE GIRARDEAU COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CAPE GIRARDEAU COUNTY HEALTH DEPARTMENT
Other - Org Name:CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-335-7846
Mailing Address - Street 1:PO BOX 1839
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1839
Mailing Address - Country:US
Mailing Address - Phone:573-335-7846
Mailing Address - Fax:573-335-5909
Practice Address - Street 1:1121 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7708
Practice Address - Country:US
Practice Address - Phone:573-335-7846
Practice Address - Fax:573-335-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO512121807Medicaid
MO512121807Medicaid