Provider Demographics
NPI:1841360880
Name:COUNTY OF WRIGHT DIVISION OF HEALTH
Entity type:Organization
Organization Name:COUNTY OF WRIGHT DIVISION OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDCASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:417-741-7791
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:300 S. MAIN SUITE C
Mailing Address - City:HARTVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65667-0097
Mailing Address - Country:US
Mailing Address - Phone:417-741-7791
Mailing Address - Fax:417-741-7108
Practice Address - Street 1:300 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:MO
Practice Address - Zip Code:65667-0097
Practice Address - Country:US
Practice Address - Phone:417-741-7791
Practice Address - Fax:417-741-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511187502Medicaid
MO000045004Medicare ID - Type Unspecified
MO1701Medicare ID - Type Unspecified
MO511187502Medicaid