Provider Demographics
NPI:1942288907
Name:COUNTY OF APPANOOSE
Entity Type:Organization
Organization Name:COUNTY OF APPANOOSE
Other - Org Name:APPANOOSE COUNTY BOARD OF HEALTH AND OR APPANOOSE COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MS, RN
Authorized Official - Phone:641-437-4332
Mailing Address - Street 1:209 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1805
Mailing Address - Country:US
Mailing Address - Phone:641-437-4332
Mailing Address - Fax:641-856-5575
Practice Address - Street 1:209 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1805
Practice Address - Country:US
Practice Address - Phone:641-437-4332
Practice Address - Fax:641-856-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099519251E00000X
IA121758251E00000X
IA069507251E00000X, 251K00000X, 261QC1500X, 261QP0905X, 261QR1300X
IA126089251E00000X, 251K00000X, 261QC1500X, 261QP0905X, 261QR1300X
IA080810251E00000X, 251K00000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670521Medicaid
IA167052Medicare Oscar/Certification
IA167052Medicare Oscar/Certification