Provider Demographics
NPI:1578537981
Name:STE GENEVIEVE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:STE GENEVIEVE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-883-7411
Mailing Address - Street 1:P.O. BOX 49
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-7201
Mailing Address - Country:US
Mailing Address - Phone:573-883-7411
Mailing Address - Fax:573-883-5857
Practice Address - Street 1:115 BASLER DRIVE
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-7201
Practice Address - Country:US
Practice Address - Phone:573-883-7411
Practice Address - Fax:573-883-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO512165804Medicaid
MO512165804Medicaid
MO45055Medicare PIN