Provider Demographics
NPI:1497756167
Name:LAFAYETTE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAFAYETTE COUNTY HEALTH DEPARTMENT
Other - Org Name:LAFAYETTE COUNTY HEALTH OFFICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-259-4371
Mailing Address - Street 1:547 S. BUSINESS HWY. 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1437
Mailing Address - Country:US
Mailing Address - Phone:660-259-4371
Mailing Address - Fax:660-259-6250
Practice Address - Street 1:547 S. BUSINESS HWY. 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1437
Practice Address - Country:US
Practice Address - Phone:660-259-4371
Practice Address - Fax:660-259-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511924508Medicaid
MO9003954Medicare ID - Type Unspecified