Provider Demographics
NPI:1750416251
Name:HICKORY COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:HICKORY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:VADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-745-2138
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668-0021
Mailing Address - Country:US
Mailing Address - Phone:417-745-2138
Mailing Address - Fax:417-745-2400
Practice Address - Street 1:24885 STATE HWY 254
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:MO
Practice Address - Zip Code:65668-0144
Practice Address - Country:US
Practice Address - Phone:417-745-2138
Practice Address - Fax:417-745-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511297202Medicaid