Provider Demographics
NPI:1932473907
Name:GRANT COUNTY AUDITOR/
Entity Type:Organization
Organization Name:GRANT COUNTY AUDITOR/
Other - Org Name:GRANT COUNTY HEALTH DEPT/NURSING DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICIER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:765-662-0377
Mailing Address - Street 1:401 S ADAMS ST
Mailing Address - Street 2:GRANT COUNTY HEALTH DEPT/NURSING DIVISION
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-2037
Mailing Address - Country:US
Mailing Address - Phone:765-662-0377
Mailing Address - Fax:765-662-9028
Practice Address - Street 1:401 S ADAMS ST
Practice Address - Street 2:GRANT COUNTY HEALTH DEPT/NURSING DIVISION
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-2037
Practice Address - Country:US
Practice Address - Phone:765-662-0377
Practice Address - Fax:765-662-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAK4109422251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNURSING102Medicaid