Provider Demographics
NPI:1922095025
Name:PERRY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PERRY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAURENTIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-6564
Mailing Address - Street 1:406 N SPRING ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1935
Mailing Address - Country:US
Mailing Address - Phone:573-547-6564
Mailing Address - Fax:573-547-3908
Practice Address - Street 1:406 N SPRING ST
Practice Address - Street 2:SUITE #1
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1935
Practice Address - Country:US
Practice Address - Phone:573-547-6564
Practice Address - Fax:573-547-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare