Provider Demographics
NPI:1871508622
Name:COUNTY BOARD OF TRUSTEES
Entity Type:Organization
Organization Name:COUNTY BOARD OF TRUSTEES
Other - Org Name:REYNOLDS COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-648-2498
Mailing Address - Street 1:2323 GREEN ST
Mailing Address - Street 2:P O BOX 40
Mailing Address - City:CENTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63633
Mailing Address - Country:US
Mailing Address - Phone:573-648-2498
Mailing Address - Fax:573-648-2510
Practice Address - Street 1:2323 GREEN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MO
Practice Address - Zip Code:63633
Practice Address - Country:US
Practice Address - Phone:573-648-2498
Practice Address - Fax:573-648-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511969800Medicaid