Provider Demographics
NPI:1699024653
Name:POLK COUNTY
Entity Type:Organization
Organization Name:POLK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY JUDE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-327-6830
Mailing Address - Street 1:602 E CHURCH ST STE 145
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-4231
Mailing Address - Country:US
Mailing Address - Phone:936-327-6830
Mailing Address - Fax:936-327-6873
Practice Address - Street 1:602 E CHURCH ST STE 145
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-4231
Practice Address - Country:US
Practice Address - Phone:936-327-6830
Practice Address - Fax:936-327-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals