Provider Demographics
NPI:1184740334
Name:COUNTY OF MCDONALD
Entity type:Organization
Organization Name:COUNTY OF MCDONALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-223-4351
Mailing Address - Street 1:500 OLIN ST
Mailing Address - Street 2:PO BOX 366
Mailing Address - City:PINEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64856
Mailing Address - Country:US
Mailing Address - Phone:417-223-4351
Mailing Address - Fax:
Practice Address - Street 1:500 OLIN ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64856-0366
Practice Address - Country:US
Practice Address - Phone:417-223-4351
Practice Address - Fax:417-223-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO510564017Medicaid
MO000045050Medicare PIN