Healthcare Provider Details

I. General information

NPI: 1871508622
Provider Name (Legal Business Name): COUNTY BOARD OF TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 GREEN ST
CENTERVILLE MO
63633
US

IV. Provider business mailing address

2323 GREEN ST P O BOX 40
CENTERVILLE MO
63633
US

V. Phone/Fax

Practice location:
  • Phone: 573-648-2498
  • Fax: 573-648-2510
Mailing address:
  • Phone: 573-648-2498
  • Fax: 573-648-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHLEEN ZIMMERMAN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 573-648-2498