Provider Demographics
NPI:1477584647
Name:COUNTY OF CAMDEN
Entity type:Organization
Organization Name:COUNTY OF CAMDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-346-5479
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:1976 NORTH BUSINESS RT 5
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-0816
Mailing Address - Country:US
Mailing Address - Phone:573-346-5479
Mailing Address - Fax:573-346-0173
Practice Address - Street 1:1976 N BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-2612
Practice Address - Country:US
Practice Address - Phone:573-346-5479
Practice Address - Fax:573-346-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12485519251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511176208Medicaid
MO511176208Medicaid