Healthcare Provider Details

I. General information

NPI: 1477584647
Provider Name (Legal Business Name): COUNTY OF CAMDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 N BUSINESS ROUTE 5
CAMDENTON MO
65020-2612
US

IV. Provider business mailing address

PO BOX 816 1976 NORTH BUSINESS RT 5
CAMDENTON MO
65020-0816
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5479
  • Fax: 573-346-0173
Mailing address:
  • Phone: 573-346-5479
  • Fax: 573-346-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number12485519
License Number StateMO

VIII. Authorized Official

Name: TONDA DAMPIER
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-346-5479