Provider Demographics
NPI:1619957313
Name:STODDARD COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:STODDARD COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-568-4593
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:1001 HWY 25 N
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63825-0277
Mailing Address - Country:US
Mailing Address - Phone:573-568-4593
Mailing Address - Fax:573-568-4736
Practice Address - Street 1:1001 HWY 25 N
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:63825-0277
Practice Address - Country:US
Practice Address - Phone:573-568-4593
Practice Address - Fax:573-568-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare