Provider Demographics
NPI:1699411595
Name:SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
Entity Type:Organization
Organization Name:SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
Other - Org Name:SOCIAL WELFARE BOARD DENTAL OF BUCHANAN COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CARMEL
Authorized Official - Last Name:JUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-344-5201
Mailing Address - Street 1:904 S 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2400
Mailing Address - Country:US
Mailing Address - Phone:816-233-5189
Mailing Address - Fax:816-344-5247
Practice Address - Street 1:904 S 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2400
Practice Address - Country:US
Practice Address - Phone:816-233-5189
Practice Address - Fax:816-344-5247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-12
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1497024145Medicaid