Provider Demographics
NPI:1790804128
Name:STONE COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:STONE COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-272-0050
Mailing Address - Street 1:701 OLD WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:REEDS SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:65737-8626
Mailing Address - Country:US
Mailing Address - Phone:417-272-0050
Mailing Address - Fax:417-272-9058
Practice Address - Street 1:701 OLD WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:REEDS SPRING
Practice Address - State:MO
Practice Address - Zip Code:65737-8626
Practice Address - Country:US
Practice Address - Phone:417-272-0050
Practice Address - Fax:417-272-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO511209207251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511209207Medicaid