Provider Demographics
NPI:1023308616
Name:CARROLL COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CARROLL COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-765-4523
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-1566
Mailing Address - Country:US
Mailing Address - Phone:765-564-3420
Mailing Address - Fax:765-564-6161
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1566
Practice Address - Country:US
Practice Address - Phone:765-564-3420
Practice Address - Fax:765-564-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare