Provider Demographics
NPI:1629497318
Name:COUNTY OF WORTH
Entity Type:Organization
Organization Name:COUNTY OF WORTH
Other - Org Name:WORTH COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:641-324-1741
Mailing Address - Street 1:95 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:50459-1436
Mailing Address - Country:US
Mailing Address - Phone:641-324-1741
Mailing Address - Fax:641-324-2195
Practice Address - Street 1:95 9TH ST N
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:IA
Practice Address - Zip Code:50459-1436
Practice Address - Country:US
Practice Address - Phone:641-324-1741
Practice Address - Fax:641-324-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA067043Medicaid
IA67043OtherBLUE CROSS BLUE SHIELD
IA167043Medicare UPIN