Provider Demographics
NPI:1659516458
Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/PUBLIC HEALTH NURSE
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:J
Authorized Official - Last Name:REIDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-584-1155
Mailing Address - Street 1:325 S OAK ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-2247
Mailing Address - Country:US
Mailing Address - Phone:765-584-1155
Mailing Address - Fax:765-584-9059
Practice Address - Street 1:325 S OAK ST STE 202
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-2247
Practice Address - Country:US
Practice Address - Phone:765-584-1155
Practice Address - Fax:765-584-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TA4050Medicare PIN