Healthcare Provider Details

I. General information

NPI: 1427612746
Provider Name (Legal Business Name): DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DYS DR
CABOOL MO
65689-9166
US

IV. Provider business mailing address

PO BOX 1359
AVA MO
65608-1359
US

V. Phone/Fax

Practice location:
  • Phone: 417-962-4344
  • Fax:
Mailing address:
  • Phone: 417-683-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HEINLEIN
Title or Position: COO
Credential:
Phone: 417-683-4831